SAMBURU COUNTY GOVERNMENT COUNTY HEALTH SECTOR MONITORING AND EVALUATION PLAN (2018- 2022) 1 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Any part of this document may be freely reviewed, quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used in conjunction with commercial purposes or for profit. Samburu County Government, Department of Medical Services, Public Health and Sanitation: Health Sector Monitoring and Evaluation Plan 2019-2012. Published by: County Government of Samburu Department of Medical Services, Public Health and Sanitation P. O. Box 12-20600, Maralal Phone: +254 065 62456, +254 65 62075 Email: info@samburu.go.ke Web: www.samburu.go.ke 2 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Table of Contents Table of Contents 2 List of Tables 4 List of Figures 4 Acronyms and Abbreviations 5 Foreword 8 Acknowledgement .............................................................................................................................................................................................9 Executive Summary 10 Chapter 1: Introduction 12 1.1 County Health Sector 12 1.2 County Monitoring and Evaluation for Health 14 1.3 Purpose of the M&E Plan 15 1.4 Process of Development 16 Chapter 2: Monitoring and Evaluation Mechanisms 17 2.1 Health Sector M&E Logical Framework 17 2.2 Monitoring and Evaluation Matrix 19 Chapter 3: Operationalization of M & E Plan through Stewardship Goals 34 3.1 Support Establishment of a Common Data Architecture 34 3.2 Enhancing sharing of data and promoting use of information for decision-making 34 3.2 Data Management 36 3.2.1 Coordination of Data Collection 36 3.2.2 Data Collection Methods and Tools 37 3.2.3 Data Quality 37 3.3 Improving Performance Monitoring and Review Processes 37 3.3.1 Scope of the Monitoring and Review 38 3.3.2 Performance Monitoring as a Decision Making and Learning Tool 38 3.3.3 Performance Review 39 3.3.4 Data Demand and Use Framework 39 Chapter 4: Implementation of the M&E Plan 44 4.1 Implementation Arrangements 44 4.1.1 Coordination of County Health Monitoring and Evaluation 44 4.1.2 Linkage with stakeholders 46 4.2 Operational Guidelines and Tools for County Health M&E 47 4.3 Dissemination of Information and Information Products 47 4.3 Key Responsibilities for Samburu Health Sector M&E 48 4.5 Monitoring & Evaluation Implementation Framework 52 Chapter 5: Evaluation Plan 57 5.1 Introduction 57 5.2 What will be evaluated? 57 Annexes 62 Annex 1: Indicator Definition Manual 62 Annex 2: Data Management and Reporting Responsibilities 70 Annex 3: County Key Indicators Targets 73 Annex 4: Service Outcome and Output Targets for the Achievement of County Objectives 79 Annex 5: Standard Operating Procedures (SOPs) 83 3 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 6: References 97 Annex 7: List of Contributors 98 List of Tables Table 2: Health Status on Key Impact Indicator 17 Table 4: Monitoring and Evaluation Matrix 21 Table 5: Data source and collection tools 33 Table 6: Highlights the required mechanisms needed for performance review 38 Table 7: Data demand and use plan for selected programmatic questions 39 Table 8: Key Responsibilities and functions of the M&E unit 42 Table 9: Monitoring and Evaluation Action Plan Timeline 46 Table 10: Monitoring & Evaluation Budget 48 Table 11: Evaluation Plan 52 List of Figures Figure 1: Basic Monitoring and Evaluation Framework 20 Figure 2: Data Flow Diagram 35 Figure 3: County M&E Organogram 45 4 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Acronyms and Abbreviations ANC Antenatal Care APRP Annual Performance Review and Plan ARVs Antiretroviral BCC Behaviour Change Communication BCG Bacilli Calmette-Guerin BEmONC Basic Emergency Obstetric and Newborn Care BMI Body Mass Index CASCO County AIDs and STI Coordinator CDH County Director Health CDSC County Disease Surveillance Coordinator CECM County Executive Committee Member CEmONC Comprehensive Emergency Obstetric and New- born Care CHC Community Health Committee CHA Community Health Assistance CHMT County Health Management Team CHRI- County Health Record and Information OfficerCounty OCHSIP Health Strategic Investment Plan CHW Community Health Volunteer CIMES- County Integrated Monitoring and Evaluation System Com- CLTS munity-led Total Sanitation CNC County Nutrition Coordinator COH Chief Officer Health CPD Continuing Professional Development CP County Pharmacist CPHO County Public Health Officer CRHC County Reproductive Health Coordinator CSFP Community Strategy Focal Person CU Community Unit CWC Child Welfare Clinic CMLAP II County Measurement Learning and Accountability DDIU Data Demand and Information Use DDSC Division of Disease Surveillance and Control DHIS2 District Health Information Software-2 DMR Data Management Register DPT Diphtheria, Pertussis and Tetanus DQA Data Quality Audit EHR Electronic Health Records EMMS Essential Medicines and Medical Supplies ESHE Enabling Sustained Health Equity FIC Fully Immunized Child FP Family Planning 5 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) GDP Gross Domestic Product GOK Government of Kenya HAO Health Administration Officer HIS Health Information System HIV Human Immunodeficiency Virus HMIS Health Management Information System HRIO Health Records and Information Officer iHRIS Integrated Human Resources Information System HSP Health Service Provider HSSF Health Sector Service Fund HCW Health Care Worker ICD International Classification of Diseases and health-related- problems ICT Information and Communication Technology IDSR Integrated Disease Surveillance & Response IEC Information, Education and Communication IMAM Integrated Management of Acute Malnutrition KABP Knowledge Attitude Beliefs & Practice KDHS Kenya Demographic and Health Survey KEBS Kenya Bureau of Standards KHSSP Kenya Health Sector Strategic Plan LLITN Long-Lasting Insecticide-treated Net M&E Monitoring and Evaluation MDA Mass Drug Administration MDG Millennium Development Goal MOH Ministry of Health NCDs Non-communicable Diseases NHIF National Hospital Insurance Fund NIMES National Integrated Monitoring and Evaluation System NGO Non-Governmental Organization NTDs Neglected Tropical Diseases OPD Outpatient Department OPV Oral Polio Vaccine PMTCT Prevention of Mother-to-Child Transmission PO Project Officer PRB Population Reference Bureau RDT Rapid Diagnostic Test RMNCAH Reproductive Maternal New-born Child & Adolescent Health SCHMT Sub-County Health Management Team SCHRIO Sub-County Health Records Information Officer SCHSSP Samburu Health Sector Strategic Plan 6 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) SCMLT Sub-County Medical Laboratory Technologist SCMOH Sub-County Medical Officer for Health SD Standard Deviation SMARTA Specific, Measurable, Attainable, Realistic, Timely Agreeable- SMART Standardized, Monitoring, Assessment, Relief, Transition SOP Standard Operating ProcedureTransforming Health Sys- THS - UC tems- Universal Care TB Tuberculosis TOR Terms of Reference TWG Technical Working Group USAID United States Agency for International Development WVK World Vision Kenya 7 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Foreword The County Government of Samburu is committed to the establishment of a harmonized health sector Monitoring and Evaluation system that truly promotes transparency and accountability. Towards this end, the county health sector has developed a strategic plan for the five-year period 2018 to 2022, and a Monitoring and Evaluation plan to provide guidance on focused tracking of the specific goals and objectives of the sector. This approach is informed by the national health sector policy orientations and the county’s overall agenda of integrating monitoring and evaluation agenda. Implementing the County Health M&E Plan will be a major step in pursuit of County’s vision statement of A county free from preventable diseases and ill health. This vision is attainable if there is commitment by all stakeholders, substantial investments in the county health system, and a robust monitoring strategy characterised by clearly defined indicators that support periodic evaluation of the health care delivery system. The M&E Plan provides the roadmap for measuring achievements of the County Health Sector Strategic Plan and the County Health System as a whole. It defines data collection, management, and dissemination mechanism. Further, it elaborates how the county health sector will be monitored, reviewed and evaluated. A comprehensive list of indicators at various levels – input, process, output, and outcome are embedded. With the full implementation of this plan, gaps in the health delivery system will be identified, improvement in data collection and management will be addressed and prompt interventions will be affected for the benefit of stakeholders and citizens of Samburu County. I wish to express my gratitude to all those who committed their efforts, time and resources in the preparation of this M&E Plan. I remain confident that the implementation of this plan is critical and achievable. I appeal to all stakeholders to offer their support in the implementation of this plan as we seek to transform the delivery of health services in Samburu County. Hon. Stephen Lekupe County Executive Committee Member for Medical Services, Public Health and Sanitation, Samburu County 8 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Acknowledgement The Samburu County Health Monitoring and Evaluation Plan 2018-2022 was developed with the support of numerous individuals and organisations. The County Government is appreciative of the leadership offered by H.E Julius Leseeto, the Deputy Governor and the County Executive Committee Member for Health; the overall coordination by Dr. Martin Thuranira, County Director for Health. Contributions by the members of CHMT and SCHMT and representatives of partners during the various stages of development of this document were crucial in enriching the content of this final draft. We are grateful to the County Health M&E Unit Coordinator, Geoffrey Mukuria for provided coordination in ensuring that required information was availed on time and coordinating logistics. We applaud USAID funded partners representatives from CMLAP II, Afya Timiza, NHP Plus and Population Reference Bureau, as well as Uzazi Salama, and World Vision programs for their insights and contributions. USAID funded CMLAP II and Afya Timiza provided financial and technical support that was fundamental towards completion of this plan. Once more, I am pleased to recognize and appreciate the dedicated sacrifices and commitments of partners and individuals who have contributed immensely to the development of this plan. It is my hope that this document will be implemented in full and that the Department of Health’s M&E Unit continues to work with these individuals, programs and partner organizations as we deliver on the promises in our CHSSP. Samuel Nakope, Chief Officer of Medical Services, Public Health and Sanitation 9 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Executive Summary The County Health Monitoring and Evaluation Plan is a significant step in a series of interventions aimed at strengthening the M&E capacity of the Samburu County Health Sector. The County Government of Samburu underscores the crucial role of a robust M&E system in generating useful information for decision making, measuring performance and fostering learning. The M&E plan will facilitate the application of a harmonized approach in tracking performance across all the health programs within the county health sector and ensure that the programs contribute to the overall desired results articulated in the strategic plan and the County Integrated Development Plan (CIDP). The County Government envisages that M&E will be integrated into the daily work of the county staff as well as other stakeholders. In this way, M&E systems will enable generation and sharing of data and information, thus promoting greater accountability and continuous learning. The development of this M&E Plan for the County Health Sector Strategic Plan is premised on the need to establish a robust monitoring and evaluation platform that provides information to all stakeholders for planning and evidence-based decision making. This is also in line with the requirements of the Constitution of Kenya 2010 in terms of advancing rights to health and information, and accountability in service delivery. Legislations including the County Government Act, 2012 and Public Financial Management Act, 2012, the Health Act, 2017, Inter-Governmental Relations Act, 2012 do also affirm the requirements for monitoring and evaluation in entrenching accountability through establishment of appropriate systems for data collection, reporting, information sharing, and feedback. Similarly, health sector policies including the Kenya Health Policy (2014 -2030), the Health Information System Policy do also lay specific requirements and provide guidance on strengthening accountability mechanisms. This plan is informed by a situational assessment of the M&E situation in Samburu County Health Sector. A review of the County Health Sector M&E plan for the period 2013 to 2018 was undertaken with a view to establishing the level of implementation and identifying key strategic issues for monitoring and evaluating the recently developed County Health Sector Strategic Plan (2018- 2022). The analysis indicates that the County Health Department has formulated the necessary strategic direction for supporting M&E activities and commenced the setting up of the necessary institutional arrangements. Challenges were identified with regards to the capacity at the various levels to collect, process and disseminate information at the various levels of the county health system. Further, the need was identified for increasing resources allocated to M&E and improving the coordination of the various stakeholders in the county health system. This M&E plan is therefore designed to provide a common platform for the health sector performance monitoring and evaluation by guiding all actors at the county, sub-county, facility, and community levels. It envisages that the County will build the capacity of the existing workforce in data management and information use at all levels for better planning and decision making. Further, it will enhance the health sector of coverage outcomes and investments at all levels applying impact indicators, outcome indicators, process indicators, and input indicators. The plan lays out specific measures for data collection, analysis, and reporting. In addition, it provides guidance on how the county health sector will carry out regular performance monitoring at the facility level, sub-county level and county level. The M&E plan provides a detailed analysis of the M&E audience information requirements to facilitate effective and responsive data collection and reporting procedures. These are anchored on a countywide health strategic M&E logical framework that illustrates the causal chain of inputs/processes, outputs and outcomes that ultimately lead to the achievement of the overall goal of the County Health Sector Strategic Plan. The indicators selected are elaborated in terms of definitions, data sources, frequency of collection and responsible persons for collection, in line with the guidance provided in the national health sector indicators and standards operating procedures manual. Further, a schedule of reporting considerations and requirements has been included to facilitate timely and accurate reporting. The M&E plan has an elaborate evaluation plan that provides for various evaluations to be undertaken during the implementation of the CHSSP. 10 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) To facilitate effective implementation of this M&E plan, institutional arrangements that support accountability at all levels of the county health system and embed alignment to the national M&E system and countywide M&E system will be enabled. Specifically, appropriate stakeholder coordination structures including a stakeholder coordination steering committee and M&E Technical Working Group will be established. Further, the existing M&E unit at the health department will be strengthened with a budget and human resources to support the effective delivery of M&E activities. 11 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Chapter 1: Introduction 1.1 County Health Sector Samburu County, which covers an area of approximately 21,022 Sq. Km. is the tenth largest county amongst Kenya’s 47 counties. The county has an estimated population of 331,376 people and 66,275 households (2009 KNBS). The population is distributed across three administrative sub-counties of Samburu Central, Samburu East and Samburu North as 153,668, 90,267, and 87,442 respectively. Over the past five years the county has registered progressive improvement in the health sector. Despite life expectancy is below national average, the mortality indicators estimates are below the national ones. The main causes of mortality in the county are HIV and AIDS, Tuberculosis, Malaria, Ppneumonia, and Diarrheal diseases. The burden of non-communicable diseases remains a challenge in the county in terms of financial risk exposure to households and as a cause of mortality. Furthermore, prevailing health risk factors such as malnutrition, poor housing, pollution, unsafe water poor hygiene and unsafe sex expose the population to the top morbidity and mortality conditions. Table 1 summarise the key health indicators and comparison against national estimates. Table 1: Key Health Impact Indicators Impact level Indicators National KDHS County estimates (status as at 2017) Life Expectancy at birth (years) 52 Male Life Expectancy at birth (years) 63 53 Female Life Expectancy at birth (years) 65 56 Annual deaths (per 1,000 persons) – Crude 8.9 2*/1000,6/100,000 mortality Neonatal Mortality Rate (per 1,000 births) 15 11*/1000 Infant Mortality Rate (per 1,000 births) 39 34*/1000 Under 5 Mortality Rate (per 1,000 births) 52 50*/1000 Maternal Mortality Rate (per 100,000 443/100,000 362*/100,000 births) Adult Mortality Rate (per 1000 population) 183*/1000 Children under five years stunted 35/100 Source: *KDHS 2014. National Estimates. Samburu County has not performed well in some health indicators especially Reproductive Maternal Newborn Child and Adolescent Heath (RMNCAH). In response, interventions have been introduced to improve these indicators including free health services in all tier 2 facilities and free maternity services in all facilities. This includes the results-based programs such as Beyond Zero, THS-UC and Performance Based Financing (PBF) with specific targets for RMNCAH. Some improvement varying across sub-counties, has been noted at the output and outcome indicators level with deliveries by skilled attendants at the facility increasing from 19.2% to 37%, Fully Immunized Children (FIC) from 58.8% to 68.9%, ANC fourth visit from 28.3% to 30.8%, WRA receiving Family Planning (FP) commodities from 17.8% to 26.7%. Other interventions were also introduced to specifically address the high burden of diseases such as HIV/AIDS, TB, and Respiratory Tract Infections. Notably, HIV/AIDS control programming showed progress, with HIV prevalence rate in Samburu County reducing from 4.8% ( KAIS, 2012) to 1.8% (Kenya HIV/AIDS Estimates Report 2018). TB control was challenged by HIV co-infection, it also showed improvements in cure rate rising to 86%. 12 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Non-communicable conditions represent an increasingly significant burden of ill health and deaths due to; cardiovascular diseases, cancers, respiratory diseases, digestive diseases and psychiatric conditions. Finally, injuries are relatively high (at 4.8% of new outpatient cases) in the county though anecdotally believed to be under reported. The risk factors that threaten health in Samburu County include unsafe sex, sub optimal breastfeeding, alcohol and tobacco use, poor sanitation and hygiene practices, poverty, illiteracy, among others (retrogressive cultural practices). Breastfeeding practices stands at 99.5% with exclusive breastfeeding for six months at 77.6% (KABP Survey February 2018). Tobacco and alcohol use are also high and stands at 14.3% and 27% respectively. Availability of safe water sources and sanitation facilities has also improved, particularly with support from partners. However, coverage is still low at 17%. Housing conditions remain poor with majority of the population living in manyattas. The County has over the years experienced significantly high levels of acute and chronic malnutrition. This has been exacerbated by suboptimal infant and young child feeding practices, unfavourable cultural practices, and perennial food shortages among others. The rates of malnutrition have remained persistently above the national average. In 2018 Acute Malnutrition decreased from 18.3% to 15.7%, stunting increased from 34.0% to 35.8; severe Acute malnutrition increased from 3.8% to 4.1 % and underweight decreased from 34.3% to 31.6% (SMART Survey June 2018). With such an unstable nutrition status, children are at risk of reduced cognitive ability and unproductive adult life. In terms of health systems strengthening, the county government has progressively made investments and registered improvements in health investments output at the various levels of the county health system. The county has a total of 95 health facilities including 3 hospitals 15 health centres and 60 dispensaries. These facilities are supported by 615 staff, who include 7 medical specialists, 12 medical officers, 233 nurses, 4 Pharmacists, 9 Pharmaceutical technologist, 38 Public Health Officers, 14 Nutritionists and 30 Community Health Assistants. Situational analysis reveals that the investments are still below the norms and standards envisaged under the Kenya Essential Package for Health (KEPH, 2016). The county acknowledges the contribution made by partners and stakeholders in supporting health service delivery and has been improving the coordination structures to see to it that the contribution is optimised. The main areas of supportive collaboration are in reproductive maternal, new-born child health, adolescent health, water sanitation hygiene promotion, nutrition promotion, and HIV/AIDS. Notably, the county government continues to rely mainly on the shareable revenue for the financing of most health activities. 1.2 County Monitoring and Evaluation for Health Monitoring and Evaluation (M&E) together with operational research, measures the overall performance of a programme or project and continuously evaluates achievements in targeted results. Monitoring is defined as the routine tracking of key elements selected to determine programme performance through record keeping, regular reporting, supportive supervision, surveillance systems and periodic surveys. In addition, monitoring involves assessing whether the implementation of the planned activities is consistent with the programme design through generating data on inputs, processes and outputs of an on-going programme over time. Evaluation, on the other hand, is defined as the periodic assessment of the change in targeted results that can be attributed to an intervention. It links outcome or impact directly to an intervention over time. Evaluation involves systematic use of quantitative and qualitative research methods to investigate the programme’s effectiveness, efficiency, relevance, sustainability and impact to determine the extent to which the investment has yielded the expected results (Guidelines for the Institutionalisation of Monitoring and Evaluation in the Health Sector, 2014). The need to have systems that support accountability to the citizens is entrenched in the Constitution of Kenya, 2010 and various legislations such as the County Government Act, 2012; the Public Financial Management Act, 2012, Intergovernmental Relations Act, 2012 and sector-specific legislation like the Health Act, 2017. As such the establishment of robust M&E system to support the county health sector is a critical ingredient for achievement of the desired level of accountability. 13 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) County governments are required to have elaborate plans laying out their agenda for the medium term and sectoral plans that articulate the sectoral agenda. The County Government of Samburu has put in place a County Integrated Development Plan for the period 2018-2022 and has a draft County Health Strategic Plan (SCHSSP) 2018 – 2022. To ensure close monitoring of the progress of implementation of health sector strategic plan, and thus drive the path to the attainment of overall health goal, the county government has put in place this M&E plan. The M&E plan outlines data needs, indicators, sources of data, data collection methods and data flow, analysis, use and reporting, feedback as well as the responsibilities of the various health stakeholders. This is in response to critical gaps identified in the County Health M&E systems that include: ineffective coordination, sub- optimal utilisation of data in decision making, inadequate physical infrastructure; inadequate personnel, inadequate supply of data collection and reporting tools and equipment, knowledge gaps in data management, research and evaluation; insufficient funding and limited use of ICT. 1.3 Purpose of the M&E Plan The overall purpose of this M&E plan is to facilitate the tracking of the progress of implementation of the County Health Sector Strategic Plan for the period 2018-2022. This plan will also facilitate the institutionalisation of the M&E principles and practices in support of decision making and adaptive learning, planning, and management across all the programs implemented by the County Health Sector. It is expected to serve as a vital tool for timely and systematic data collection, analysis and reporting with the overall goal of improving performance and accountability to stakeholders. Specifically, the M&E plan will: 1. Build coherence in the approach to systematically track performance across county health programs and ensuring that they contribute to the overall goal reflected in the County Health Sector Strategic Plan 2018-2022. 2. Define the data requirements (collection, sources, tools, collation, analysis) and assign responsibilities for effective tracking of interventions implemented at all levels. 3. Provide reporting requirements including reporting formats needed to promote timely reporting both within the county and externally to national government, partners and donors. 4. Define data feedback mechanisms and utilisation for decision making internally and among stakeholders. 5. Document progress and enhance performance through continuous learning, sharing and improvement. 1.4 Process of Development This M&E plan was developed through a participatory and consultative process that involved county health department as well as partners. Specifically, the approach applied included the following: a) Review of national and county documents to understand the M&E planning requirements and environment b) Consultative meetings with senior management of the County Department of Medical Services, Public Health and Sanitation, program managers and M&E focal persons. c) Consultations with the County Health M&E Technical Working Group and partners. d) Technical workshop to review the prior period’s M&E plan and formulate this plan. e) Final draft review and validation with stakeholders to build consensus on and obtain further feedback. 14 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Chapter 2: Monitoring and Evaluation Mechanisms This section outlines the mechanisms for monitoring and evaluation including the general monitoring framework and the county- led M&E matrix. 2.1 Health Sector M&E Logical Framework The logical M&E framework applicable to this plan is premised on the fact monitoring and evaluation will be carried out guided by performance indicators tracked at inputs, processes, outputs, outcomes, and impact level. Investments through inputs and process will result in immediate outputs, outcomes and ultimately create an impact in the health sector. At the input level, indicators related to various health systems investments such as human resources for health, health financing, policies and others, will be utilized to measure performance. The processes (training, commodities, and advocacy) will directly translate to various outputs which, in turn, and if effectively designed to reach the target populations, will result in short-term effects or outcomes such as increased coverage and service quality. Additionally, these outcomes could result in a longer-term impact of the programme on the population in terms of a reduction in disease burden, reduction in mortality, increase in life expectancy and improved well-being. These specific indicators are mapped alongside associated health policy and strategic objectives guided by the health sector strategic plan are shown in Figure 1. To enhance the M&E framework the plan will design strategies to enrich in process and end process impact evaluation thus formulating action plans based on generated data evidence, therefore informing health programs interventions. Figure 1 Basic Monitoring and Evaluation Framework End process Impact assessment In process monitoring & and plan of action 15 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 2.2 Monitoring and Evaluation Matrix The Samburu County Health Sector Strategic Plan will be monitored and evaluated as illustrated in Table 4 below. Table 4: Monitoring and Evaluation Matrix 16 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source Objective 1: To Reduce Non-Communicable Diseases % Fully • Vaccine doses • Updating/training of health care • Number of children fully Increased Reduction in DHIS (MOH immunized acquired workers on immunization policies and immunized proportion of mortality, 510,702,710), children guidelines children below increase in life HIS • Immunization • Number of facilities the age of one expectancy SURVEYS (EPI, equipment • Availing vaccines to buffer stock providing immunization year who are fully KDHS, KSPA) immunized KNBS • cold chain • Conducting outreaches on • Number of community units immunization sensitized • Immunization information, • Sensitization of community units on • Number of health workers education and immunization policies and guidelines updated on immunization communication guidelines (IEC) materials • Conducting stakeholders’ forums on immunization • Number of immunization • Training and defaulters traced capacity building • Conducting quarterly data review for health care meetings on immunization providers plans • Outreach services. % of target • Human resources • Creation of awareness, • Number of outreaches Reduced Reduction of MDA registers population • Conduct supervision conducted, schistosomiasis mortality and tally receiving Multi- • Training • Procure supplies. • Number of supplies procured sheets, Drug and distributed demographic • available funds, • Number of supervisions estimation Administration conducted (MDA) for • Equipment and schistosomiasis supplies. Trachoma, Snake bites 17 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source % of TB • Partners supporting • Updating/training of health care • Number of health care Increased Reduction of TB Treatment patients the TB program workers and community health workers and community proportion mortality Register, MOH completing volunteers on current TB policies and health volunteers trained / of bacteriologically 711, TIBU treatment • Updates on TB guidelines updated on TB policies and confirmed TB Demographic policies and • Sensitization of community units on TB guidelines clients Estimation guidelines. policies and guidelines • Number of dialogue/action completing (HIS) treatment • Conducting quarterly data review days conducted meetings • Number of TB-related • Conducting TB stakeholders’ forum commodities procured • Updating/training of health care • Number of TB-related workers on TB and nutrition commodities distributed • Number of health care workers trained on TB and nutrition % HIV+ • Human resources • Conduct awareness on PMTCT • Number of outreaches Reduced MTCT of Reduction in MOH 405,333, pregnant conducted HIV mortality 406,731(HIS) mothers • available funds • Conduct supervision, procure supplies • Number of supplies procured receiving and conduct training. and distributed preventive • Number of supervisions antiretroviral conducted (ARVs) % of HIV+ • Partners supporting • Updating/training of HIV testing • Number of HTC providers 90% of people Reduction in ART registers clients on ARVs the HIV/ AIDS and counseling (HTC) providers on trained / updated on HIV living Mortality (HIS) program treatment guidelines management guidelines with HIV/AIDS accessing • Supplies and • Sensitization of community units on • Number of community care and equipment HIV/AIDS policies and guidelines units sensitized on HIV/AIDS treatment policies and guidelines • IEC materials on • Conducting quarterly HIV/AIDS HIV/AIDS meetings • Number of HIV-related commodities procured • Conducting HIV/AIDS stakeholder forum • Number of HIV-related commodities distributed 18 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source Under-5s Skilled human Conduct outreaches, conduct Number of outreaches Reduced cases Reduction in MOH 204 A, treated for resources, transport, training, procure supplies, community conducted of under-five under 5 mortality MOH 705 A diarrhea structure, available sensitization, and conduct supervision. diarrhea cases or (HIS) funds, equipment, Number of supplies procured increased child supplies. and distributed survival Number of supervisions conducted Number of health care workers (HCWs) trained School age Human resources, Human resources, school health Number of outreaches Increased child SURVEYS, children de- transport, structure, outreaches, supplies, reporting, training. conducted survival rate REPORTS wormed available funds, Reduction in (HIS), School equipment, supplies. Number of supplies procured morbidity health (6-14 yrs.) and distributed program Number of supervisions MOH 708 conducted Number of health care workers (HCWs) trained 12-59 months Human resources, Conduct outreaches, conduct Number of outreaches Increased child MOH 713 Children de- transport, structure, training, procure supplies, community conducted survival rate (HIS), ECDE wormed available funds, sensitization, conduct supervision, and Vit A and equipment, supplies. conduct training. Number of supplies procured Dewormers and distributed Number of supervisions conducted Number of health care workers (HCWs) trained Objective 2: To Halt, and Reverse Burden of Non-Communicable Conditions 19 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source % of adult Human resources, Develop health promotion package on Number of sensitization Reduced /halted Reduction in Survey population equipment, healthy lifestyle, conduct mass screening, meetings on lifestyle held non-communicable mortality with Body Mass documentation tools, regulate/ enact/enforce laws that govern conditions HIS Index (BMI) logistics. food markets, establish recreation Number of recreation centers centers. initiated over 25 Number of mass screenings conducted Number of laws enacted/ enforced % women of • Number of partners • Updating/training of health care • Number of health care Increased Reduction in ANC register, reproductive supporting the workers on cervical cancer screening, workers (HCWs) proportion of mortality Post-natal age screened cervical cancer management and referral register, Family for cervical screening program • trained / updated on women of planning, • Updating community health cervical cancer screening, reproductive cervical cancer Cancers • Updates on cervical volunteers on cervical cancer advocacy management and referral service register, cancer screening, and referral age screened for OPD register management and • Number of community cervical (HIS) referral policies and • Procurement and distribution of health volunteers guidelines. cervical cancer equipment and cancer commodities • updated on cervical cancer advocacy and referral • Conducting cervical cancer stakeholders’ forum • Amount of cervical cancer equipment and related • Conducting quarterly cervical cancer commodities procured data review meetings New outpatients Skilled human Establish mental health units in high Number of mental health Reduced /halted Reduction in Outpatient with mental resources, volume sub-county hospitals. centers providing outpatient non-communicable mortality registers health documentation services conditions conditions tools, logistics. (HIS) 20 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source New outpatients’ Skilled human Create awareness of the risk of • Number of health education Number of new Improvement of OPD REGISTER cases with high resources, hypertension and the importance of sessions conducted monthly outpatients with well being MOH 204 B, blood pressure documentation tools, regular checkups; conduct mass screening, high blood pressure OPD summary logistics. establish rehabilitation centers. • Number of public awareness seen. sheet (FORM sessions on importance of Reduced/halted 705B), HIS regular checkups conducted burden of non- monthly communicable conditions Patients Skilled human Procure the medical equipment for Number of screening Reduced /halted Improvement of OPD REGISTER admitted with resources, screening, supply of drugs. equipment procured non-communicable wellbeing and life MOH 204 B and cancer documentation tools, Number of stock-out of drugs conditions Improved expectancy OPD summary logistics reported treatment outcome Reduction in sheet (FORM of case load, mortality 705B (HIS) reduced new cancer cases Objective 3: To Reduce the Burden of Violence and Injuries New outpatient • Partners supporting • Updating/training of health care • Number of health care Increased Minimize effects of GBV register cases attributed services dealing workers on the sexual and gender- workers trained / updated proportion of GBV (HIS), Survey to gender-based with sexual and based violence program on SGBV management and SGBV survivors violence gender-based • Updating community health volunteers referrals violence accessingon SGBV advocacy and referrals • Number of community health volunteers updated health care • Updates on sexual • Upgrading health facilities so that they can offer services dealing with SGBV on SGBV advocacy and servicesand gender- referrals based violence • Procurement and distribution of management and equipment and commodities that can • SGBV-related equipment referral policies and assist SGBV survivors and commodities procured guidelines • Conducting SGBV stakeholders’ forum • Number of health facilities offering services dealing • Conducting quarterly SGBV data review with SGBV meetings 21 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source New outpatient Skilled human Training of staff on how to handle Number of staff trained to Reduction in the Reduce mortality Outpatient cases attributed resources, available emergencies. handle emergencies. number of deaths and morbidity registers (HIS) to road traffic funds, medical and disabilities related to RTA injuries equipment, drugs, due to road traffic advocacy and accidents. enforcement of traffic rules, infrastructure and medical supplies. New outpatient Skilled human Community sensitization and respecting Number of community Reduced number of Reduce mortality Outpatient cases attributed resources, available the rule of law. sensitization meetings held other injuries and morbidity registers (HIS) to other injuries funds, medical related to other equipment, drugs, injuries advocacy and enforcement of traffic rules, infrastructure and medical supplies. Deaths due to Ambulance services. Upgrade county referral hospital to have County referral hospital Coordinated Reduce mortality Death injuries ICU facilities, equip ambulances. with capacity to handle emergency and morbidity registers (HIS), emergencies. Availability of servicesZdue to related to other KDHS, Census well-coordinated ambulance injuries injuries services Number of equipped ambulances Objective 4: To Provide Essential Health Service to Samburu County By 2022 % deliveries • Guidelines and • Training of health workers • Number of health care Increased Reduce infant HIS conducted standard operating • Assessment of health facilities’ EmONC workers trained on EmONC proportion of and maternal with skilled procedures (SOPs) readiness • Number of facilities that are deliveries mortalities related attendant • Emergency • Supportive supervision EmONC compliant conducted by to deliveries obstetric and new- • Community mobilization • Number of facilities that are skilled attendants born care (EmONC) • Distribution of IEC materials CEmONC compliant checklist • Number of community units • Comprehensive that are sensitized emergency 1. obstetric and new-born care (CEmONC) checklist • IEC materials 22 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source % of pregnant Human resource, • Capacity building of health workers in • Number of HCWs whose Increased Reduce maternal HIS women equipment and IEC focused antenatal care (FANC) capacity in FANC has been proportion of &child mortality, attending four Materials • Community advocacy and mobilization built pregnant women antenatal care on FANC attending 4 ANC • Number of community units visits visits • Procurement of health commodities mobilized and sensitized on • Strengthen referral system FANC • Distribution of IEC materials • Number of health facilities supplied with commodities % of women • Training curriculum • Training of health workers on current • Number of health care Increased Reduce Maternal HIS of reproductive • Family planning FP methods workers (HCWs) trained in proportion mortality, age receiving commodities • Supportive supervision current FP methods of women of family • and equipment • Community awareness reproductive planning • Number of community units • Guidelines and SOPs • Distribution of IEC materials that are sensitized age receiving FP • IEC materials commodities % of facility Human resource, • Capacity building of health workers • Number of HCWs whose Reduced number Reduce Maternal HIS based maternal equipment and IEC • Maternal death audits at all levels capacity has been built of maternal deaths Mortality deaths Materials • Community mobilization • Number of maternal death reported audits conducted and audited • Strengthen referral system • Number of verbal • Distribution of IEC materials autopsies conducted at the community level • Number of community units sensitized % of facility- Human resource, • Building the capacity of health care • Number of HCWs whose Reduced Reduce infant HIS based under- equipment and IEC workers (HCWs) in child health capacity in child health has proportion of mortality five deaths Materials • Community advocacy and mobilization been built facility-based on child health • Number of community units under-five • Procurement of health commodities mobilized deaths reported • Strengthen referral system • and sensitized on child health Number of health • Distribution of IEC materials facilities supplied with commodities 23 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source % of new-born Human resource, • Capacity building of health care • Number of HCWs whose Increased number Reduce infant HIS with low birth equipment and IEC workers in newborn health capacity in new-born health of newborns mortality weight Materials • Community advocacy and mobilization has been built with normal birth on newborn health • Number of community units weight • Procurement of health commodities mobilized and sensitized on • Strengthen referral system new-born health • Distribution of IEC materials • Number of health facilities supplied with commodities % of facility- Human resource, • Capacity building of health workers in • Number of HCWs whose Reduced number HIS based fresh still equipment and IEC management of labor and delivery capacity in management of of births Materials • Community advocacy and mobilization labor and delivery has been on at least 4 antenatal care (ANC) visits built fresh still births • Number of community units reported • Procurement of health commodities mobilized and sensitized on • Strengthen referral system 4 ANC visits • Distribution of IEC materials • Number of health facilities supplied with commodities Objective 5: To Minimize Exposure to Health Risk Factors % population Regulatory laws • Community sensitization on NACADA • Number of community Reduced / Reduce cases / Surveys, who smoke (NACADA), guidelines, laws and by- laws, sensitizations carried out on halted non- deaths related to (NACADA), by-laws on NACADA laws, communicable smoking KDHS, Census smoking and miraa conditions due to consumption smoking % of salt brands Funds available • sensitization on use of iodized salt • use of iodized salt, Reduce the cases SURVEYS adequately related to intake of KNBS (KDHS), iodized un iodized salts. Sample surveys Objective 6: To Strengthen Collaboration with Health-Related Sectors 24 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Inputs Processes Outputs Outcome Impact Data Source % infants under IEC materials • Training health care workers to • Number of HCWs who have Increased Reduce infant KNBS/HIS six months promote exclusive breastfeeding been trained to promote proportion of mortality on exclusive exclusive breastfeeding infants under the breastfeeding • Community advocacy and mobilization • Number of community units age of 6 months on exclusive breastfeeding mobilized and sensitized on who are exclusively • Distribution of IEC materials exclusive breastfeeding. breastfed • Number of health facilities supplied with commodities % children IEC materials • Capacity building of health workers in • Number of HCWs whose Reduced proportion Reduce KNBS/HIS under five nutritional requirements of under-fives capacity in nutrition for of malnutrition stunted under-fives has been built children under in under-fives, • Community advocacy and mobilization • Number of community units the age of 5 years Reduced under five on nutrition in under-fives mobilized and sensitized on who have stunted mortality • Distribution of IEC materials nutrition for under-fives. growth • Number of health facilities supplied with nutrition commodities % children Human resource, • Capacity building of health workers in • Number of HCWs whose Reduced proportion Reduce under-fives KNBS/HIS under five equipment and IEC nutritional requirements of under-fives capacity in nutrition for of children under mortality underweight Materials • Community advocacy and mobilization under-fives has been built the age of 5 years on nutrition in under-fives • Number of community units who are • Distribution of IEC materials mobilized and sensitized on underweight nutrition for under-fives • Number of health facilities supplied with nutrition commodities % population Human resource, • Training of HCWs and CHVs. • Number of HCWs and CHVs Increased Reduce the burden SURVEYS, with access to equipment and IEC trained. proportion of diarrheal REPORTS; safe water Materials • Community sensitization • Number of community of households with diseases KDHS sensitizations conducted access to safe water MOH 708 )HIS % of Human resource, and • Community advocacy and mobilization • Number of community units Increased Improved SURVEYS, households IEC Materials on latrine use whose capacity in CTLS has proportion of sanitation REPORTS with latrines • Capacity building of community health been built households and waste KDHS volunteers on community led total • Number of open defecation with latrines management sanitation (CLTS) free (ODF) villages. MOH 708) HIS • Distribution of IEC materials • Number of CLTS sessions conducted. Chapter 3: Operationalization of M & E Plan through Stewardship Goals 3.1 Support Establishment of a Common Data Architecture Common data architecture is a prerequisite for achieving the One M&E framework desired for the health sector. Data architecture in this context refers to the use of standard nomenclature for services, medicines and medical supplies, cadres of staff amongst others. It also refers to the use of standard coding systems shared across all databases, as well as the use of defined standards for the exchange of patient and aggregate level data across information systems. The county health department will adopt a consistent application of standards as a data management function. This will require strong leadership at all management levels and thus it is a prerequisite in the logic framework as a key domain of the stewardship goals. 3.2 Enhancing sharing of data and promoting use of information for decision-making Data and statistics management will be enhanced through sharing and information use to allow evidence-based decision making. Data management will be coordinated at the county level. The County Department of Health will undertake the procurement and distribution of HMIS data collection and reporting tools to meet the data requirements of the county. The County Health Management Team (CHMT), through the Monitoring and Evaluation unit and the M&E TWG (TWG), will provide oversight and will coordinate initiatives in Samburu County aimed at supporting efficiency and effectiveness of electronic data management for assuring data quality, timeliness and accuracy. The CHMT, through the county health records and information officer (CHRIO), will coordinate data collection and reporting of service data through the routine health management information (HMIS) system at the community, health facility, sub-county, and county levels through the laid down structures, as illustrated in the flow chart below. The CHMT will ensure availability and adherence to standard operating procedures (SOPs) for data management. Some SOPs are included in Annex 5. DATA MANAGEMENT HIERARCHY Data Collection Compilation Storage Analysis Reporting Use National Indicator definition; Data aggregation Data National level National reports; Policy Tools development warehousing Donor reports formulation; Resource management Person(s) M&E TWG HMIS department; HMIS HMIS HMIS Policy makers responsible Divisional heads department; department; department; Divisional heads Divisional heads; Divisional heads National TWGs County Indicator definition; Data aggregation Data archiving County level County level Policy Customization; formulation; Tools development Resource allocation Person(s) CHMT, TWGs CHRIO and M&E CHRIO and M&E CHRIO and M&E CHRIO and M&E County responsible Coordinator Coordinator Coordinator Coordinator government Sub County Data verification Data entry and Data archiving Sub county and Sub county level Indicator and audit tabulation facility level monitoring Person(s) SCHRIO, SCHMT SCHRIO, SCHMT SCHRIO SCHRIO SCHRIO SCHMT responsible Facility Data Capture Collation and Data archiving Facility + Departmental Resource transmission Community and facility data Management; Health talks HRIO, facility HRIO, facility HRIO, facility HRIO, facility HRIO, facility HRIO, facility Person(s) managers managers managers managers managers managers responsible Community Data Capture Collation and Data archiving Community Unit CHEW Community transmission mobilization, Person(s) planning responsible CHEW CHEW CHEW CHEW CHEW CHEW 25 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) FEEDBACK FLOW UPWARD DATA FLOW Regular data quality audits and data and performance review forums will be conducted to track indicator performance at all levels, including community dialogue days. CHMT and SCHMT will carry out supportive supervision and provide mentorship. The county department of health will support capacity building on data management and use at all levels as well as support development and sharing of health information products. 3.2 Data Management In line with the Health Information policies and guidelines the county will manage data through setting up appropriate structures and adopting approaches to deliver packaged information that is reliable, accessible and timely to satisfy the needs of the various stakeholders. The county government will seek to provide quality data by minimizing errors and gathering maximum data for analysis, dissemination and information use. To ensure this is achieved and uniformity maintained, various standard operating procedures (SOPs) and guidelines for data management will be developed/adopted/adapted/updated and utilized. 3.2.1 Coordination of Data Collection The M&E Unit will work closely with various stakeholders at county, sub-county, facility and community levels to coordinate the collection of data that will be used to generate information products. The data collection strategy for the routine county service statistics (indicators and dataset) at the facility and county level has already been developed and rolled out through the DHIS2. This enables the collection of data from the community, health facility (public and private), sub-county, and county to the national level. The process of data collection for service delivery data will occur at various levels. • At the household level, data will be collected by the CHVs, guided by the household register, which lists all the households in the community unit. The CHV will fill in the service delivery data on a community log/diary. This log will be presented to a CHEW at the facility to which the community unit is attached. The CHEW will aggregate all the community logs received into the CHEW summary, which will be further aggregated at the sub county level into a Sub county CHEW summary and posted on DHIS. For those facilities that have DHIS access, the CHEW summary for the facility can be posted at the facility. • At the facility level, all public and private facilities and all implementing partners will collect routine service delivery data using standard tools and registers. These will then be collated into standardized reporting forms and submitted monthly into the DHIS, or from the sub county level for those facilities that do not have DHIS access. The different levels of the M&E System shall use the data for management decisions and ensure feedback is relayed to the respective levels. 3.2.2 Data Collection Methods and Tools Data collection will combine quantitative and qualitative methods and will use standardized data collection tools and techniques; the main are DHIS, LMIS, HRIS, commodity supply systems and financial systems. The survey-based indicators will be collected at baseline, mid-term where possible, and in the last year of implementation. 3.2.3 Data Quality Data quality ensures effectiveness and efficiency of evidence-based decision making at all levels. The officers in charge of data and information management will conduct data validation, interpretation and analysis by adhering to the 6 principles of data, namely, precision, reliability, validity, integrity, completeness and timeliness. The M&E unit will ensure that data is always available and accessible. Data quality will thus be maintained through supportive supervision, routine data quality assessment, data reviews, and capacity building of staff. The county will ensure that all programmes and levels of service delivery will generate and disseminate quality data to support informed decision making. 26 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 3.3 Improving Performance Monitoring and Review Processes The County Health Department’s M&E unit, in collaboration with stakeholders, will coordinate performance monitoring through periodic assessment of M&E activities and incorporating feedback as appropriate. Performance monitoring and review will be carried out at all levels on a regular basis, the frequency being driven by the sector’s need for information, as follows: • At the community level, performance monitoring and review will be done on a monthly, quarterly and annual basis. • At the facility level, it will be done on a daily, weekly, monthly, quarterly, biannual, annual and need-by-need basis. • At the sub county level, it will be done on a weekly, monthly, quarterly, biannual, annual and need-by-need basis. • At the county level, monitoring and review will be done on a weekly, monthly, quarterly, biannual, annual, midterm, end term and need-by-need basis. The M&E Unit will ensure performance reports generated are distributed to the data generating points and are also reviewed, amended and if need be, new priorities for implementation for the subsequent years identified. In addition, to the periodic performance report, there will be special surveys, such as patient exit surveys and data quality audits, that shall be undertaken by the M&E Unit. After the M&E plan is adopted, it forms the basis of performance contracting and staff performance appraisal. A mid-term review will be conducted in the third year of the strategic plan’s implementation, as well as at the end term to ascertain the county’s performance in achieving health objectives. All health stakeholders will be involved at every level. As far as possible, the M&E framework will provide critical information to inform decision making and planning among various users at the community, facility, sub-county and county levels. 3.3.1 Scope of the Monitoring and Review The M&E unit will ensure Monitoring and review will be done at all levels. The CHMT will ensure that the M&E Unit will have adequate staff and other resources to serve the county’s M&E needs and to coordinate M&E activities in the health sector. The unit’s officers will be responsible for tracking the performance of indicators in the county and producing timely and accurate monthly, quarterly and annual reports on indicators highlighting progress and challenges in implementing the various activities outlined in this M&E plan. Progress and performance monitoring will include both quantitative and qualitative assessments and will include analyses on: (1) progress towards achieving the county’s goals; (2) equity; (3) efficiency; (4) qualitative analyses of the contextual factors, and (5) benchmarks. 3.3.2 Performance Monitoring as a Decision Making and Learning Tool The performance review process will be utilized as one of the learning mechanisms in the sector. For optimal use, follow-up and learning, all performance reviews and evaluations will contain specific, targeted and actionable recommendations. The technique of performance monitoring and review is aimed at promoting accountability, supporting timely decision making and providing a basis for evaluation and learning at the community, facility, sub-county and county levels. It also helps to ensure that: • Work progresses according to schedule, • Resources are used rationally and as planned, • The required information is available and utilized, • Problems are detected in time during the implementation period to allow for corrective measures, • Plans are verified to ascertain that they are being implemented in the manner planned, and • Standards such as storage and administration of vaccines are maintained. 27 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 3.3.3 Performance Review Continuous quality improvement requires strong and regular performance review mechanisms at all implementation levels of the health sector. It is an essential component of technical accountability and guides in the establishment of priority activities. It provides a mechanism by which health care managers and service providers are held accountable for the stewardship of the resources under their care. Therefore, the county will actively participate in different forums for reviewing performance by focusing on a set of indicators selected through consensus. The results of the review processes will be packaged and disseminated widely to provide feedback throughout the sector and allowing for corrective action and mid-course adjustments resulting in the improvement of performance. Mid-term reviews will offer comparisons between planned and achieved targets to date. Table 6: Highlights the required mechanisms needed for performance review Methodology Output Frequency Prepared by Responsible person Monthly progress report Monthly progress Monthly CHEWs, Facility In charges, SCHRIO SCHMT reports; transmitted Quarterly bulletin Quarterly bulletin reports; Quarterly County M&E Unit Head of M&E unit transmitted Quarterly report Quarterly reports; transmit- Quarterly County M&E Unit/SCHRIO Head of M & E unit, ted SCHRIO Quarterly performance Quarterly performance Quarterly County M&E Unit/SCHRIO Head of M&E unit, SCHRIO review review reports; transmitted Bi-annual DQA reports Bi-annual DQA reports; Bi-annual County M&E Unit/SCHRIO Head of M&E unit transmitted Annual performance report Annual performance reports; Annual County M&E Unit/SCHRIO Head of M & E unit, transmitted SCHRIO Annual health statistical Annual health reports; Annual County M&E Unit/SCHMT Head of M&E unit, SCHRIO report transmitted 3.3.4 Data Demand and Use Framework Data demand and use will be accelerated to guide decision making and planning while taking into consideration the information needs of all stakeholders. This will further allow for advocacy, communication and social mobilization, budgeting, and operational research. It will be achieved through the data use plan, as outlined in the table 7. 28 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 29 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Table 7: Data demand and use plan for selected programmatic questions Programmatic Questions Indicator Data Source Timeline for Proposed Decisions Decision maker Communication Channel analysis How can the county Proportion (%) of MOH 362/ MOH • Quarterly • Establishment of youth friendly sites CDH/ county • Feedback meetings at all levels improve the uptake of clients accessing 731/ DHIS • Procurement of adequate HIV/AIDS AIDS and STD • Support supervision (specific to clients seeking HIV and • Monthly HIV and AIDS supplies and equipment coordinator HIV/AIDS) AIDS services? Services • Training HCWs on HTC skills • Quarterly data review meetings • Strengthening community units for involving all stakeholders referrals and linkages What is the uptake of ARVs? Proportion (%) of MOH 731/ DHIS/ • Monthly • Form MDT to review patients failing CASCO • Viral load report people living with NASCOP website • Quarterly first line regimen • Interpretation HIV on ART with • Improve ART uptake and adherence • Dissemination meeting suppressed viral load • Rapid results initiative (RRI) to • Stakeholders’ meeting identify clients with no viral load and order • Monitor clients’ progress How can the county Proportion (%) of Cancer register • Monthly • Increase the number of facilities CDH/ County • Feedback meetings at all relevant improve the uptake of women of MOH 262 • Quarterly offering cervical cancer screening reproductive levels Cervical cancer screening reproductive • Training HCWs on cervical cancer health (RH) • Support supervision (specific RH) among women of age screened for screening coordinator • Data review meetings involving reproductive age? cervical cancer • Sensitization of CHVs on cervical all the stakeholders cancer screening to enhance referrals and linkages How can the county Proportion of MOH 364 • Monthly • Training the HCWs on care and CDH/ County RH • Feedback meetings improve SGBV survivors’ SGBV survivors management of SGBV survivors Coordinator • Quarterly SGBV data review access to (post-exposure • Quarterly • Increase the Number of SGBV centers accessing PEP meetings prophylaxis (PEP) within 72 within facilities within 72 hours • Support supervision (specific hours? • Sensitization of community health SGBV) volunteers to enhance timely referrals • Stakeholders meeting How can the county Proportion (%) of MOH 405, ANC • Monthly • Community mobilization and County RH • Monthly reports increase number of pregnant women register/ MOH 333 • Quarterly sensitization Coordinator • Quarterly RH reports deliveries by skilled delivering at health Maternity register/ Biannual • Resource mobilization • Quarterly RH bulletin attendant? facilities MOH 406, Post-natal, • Annual • Capacity building in customer care • Annual work plan register/ DHIS • Structural improvement of labor • Quarterly implementation plan wards • RH Budget report 30 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Programmatic Questions Indicator Data Source Timeline for Proposed Decisions Decision maker Communication Channel analysis How can the county reduce Proportion (%) of MOH 711, MOH 511 • Monthly • Capacity building HCWs on nutrition County Nutrition • Monthly reports stunting rates among children under five CWC register/ • Quarterly screening Coordinator • Quarterly Nutrition reports children under five years? years who are stunted Biannual • Complementary and supplementary • Quarterly nutrition bulletin • Annual feedings for children under two years • Annual work plan using BFCI interventions. • Quarterly implementation plan • Conduct SMART and KAPB surveys • SMART survey reports • KAPB survey reports How can the county Proportion (%) of MOH 710, MOH • Monthly • Increase the number of children County EPI • Monthly reports improve utilization of children under one 702, MOH 510 • Quarterly reached through consistent Logistician • Quarterly EPI reports immunization services year who are fully Immunization outreaches and in-reaches • Biannual • Quarterly EPI bulletin as per EPI immunization immunized register • Ensure proper EPI commodity schedule? • Annual • Annual work planmanagement to reduce stock outs • Quarterly implementation plan • Strengthen defaulter tracing by CHVs • Facility REC categorization How can the County Proportion (%) of MOH 502, MOH 503, • Weekly • Capacity build HCWs on disease County Disease • Weekly reports improve disease health facilities with MOH 504, MOH 505 • Monthly surveillance. Surveillance • Monthly reports surveillance, reporting and timely weekly IDSR Coordinator • Quarterly • Ensure availability of collecting and • Quarterly IDSR reports response? reports. reporting tools • Biannual • Quarterly IDSR bulletin Proportion (%) of • Annual • Annual work plan outbreaks responded • Quarterly implementation plan to within 48 hours • Maternal death audit reports How can the County Proportion (%) of MOH 513, MOH 514, • Monthly • Capacity build CHVs on CBHMIS County • Monthly reports improve delivery of level population covered by MOH 515, MOH 516, • Quarterly • Improve household visits Community Health • Quarterly CHS reports 1 (community) KEPH community units. MOH 100 Development • Biannual • Capacity build CHVs on technical • Quarterly CHS bulletin services? Coordinator • Annual modules • Annual work plan • Improve referrals and linkages from • Quarterly implementation plan and to community level. • Bi-annual HH registration • Improve data capture, analysis and use • Conduct quarterly planning and performance review • Functionality assessments and supervisions 31 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Programmatic Questions Indicator Data Source Timeline for Proposed Decisions Decision maker Communication Channel analysis How can the County Proportion (%) of TB MOH 711, TIBU • Monthly • Improve on active case finding and County TB • Monthly reports improve TB prevention and cases cured demographic • Quarterly referrals and Leprosy • Quarterly TB&L reports cure rate? estimation, MOH 731, • Procurement of TB diagnostic kits Coordinator• Biannual • Quarterly TBL bulletin TB register • Annual • Ensure adherence and completion of • Annual work plan TB treatment • Quarterly implementation plan • Ensure accurate and timely diagnosis of TB cases • Ensure proper data capture, reporting and utilization. How can the county Proportion (%) of MOH • Weekly • Capacity build HCWs on proper County Malaria • Weekly reports improve on Malaria confirmed malaria • Monthly diagnosis Coordinator • Monthly reports prevention, diagnosis, cases • Quarterly • Put preventive strategies in place • Quarterly Malaria reports treatment and • Proper malaria commodity and management? • Biannual • Quarterly malaria bulletin supplies management • Annual • Annual work plan • Procurement of diagnostic • Quarterly implementation plan equipment • Strengthen surveillance and reporting How can the county Proportion (%) of KQMH tools • Monthly • Capacity build HCWs on KQMH County Quality • Monthly reports improve quality of health facilities achieving QOS • Quarterly • Establish and strengthen existing Improvement • Quarterly QI reports services? score of 80% • Biannual QITs and WITs Coordinator • Quarterly QI bulletin • Annual • Conduct regular quality • Annual work plan improvement assessment. • Quarterly implementation plan Chapter 4: Implementation of the M&E Plan Under the County Health Sector Strategic Plan for 2018-2022, streamlining the organisation of collection and utilisation of data for evidence-based decision making at all levels of the county health care system is identified as a priority. The strategy appreciates that addressing the capacity issues across the health strengthening systems is critical to improving the county health M&E system. Various initiatives, including those supported by development and implementation partners, are currently under implementation towards this end. This plan seeks to ensure that county M&E system for the health sector is linked to the County Integrated Monitoring and Evaluation (CIMES) spearheaded by the Department of Planning; as well as the national government’s health monitoring and evaluation system coordinated by the Monitoring and Evaluation unit of the national Ministry of Health and the National Integrated Monitoring and Evaluation Systems (NIMES) under the national ministry responsible for planning. In the sections that follow, the proposed coordination structures for monitoring and evaluation; proposed key activities and the attendant cost estimates are outlined. 4.1 Implementation Arrangements The coordination arrangements proposed in this plan are geared towards ensuring that the key M&E functions that focus on information generation, validation, analysis, dissemination and use towards delivery of the sector priorities identified in the strategic plan and the CIDP, are effectively and efficiently delivered. This will be achieved through collaboration with state, non-state and external actors present in Samburu County. 4.1.1 Coordination of County Health Monitoring and Evaluation The county department of health together with partners have agreed to work together in the spirit of the UNAIDS three-ones key principles (one implementation plan, one coordination mechanism, and one M&E framework). The contribution of the partners to county health M&E will be effected by ensuring partners’ efforts are in line with and coordinated by the county department of Health and, where appropriate, sharing and developing the capacity for county health M&E. Data collected by partners has to be coordinated in order for the county health department to be able to monitor, evaluate and report holistically on the progress of health interventions in Samburu County. This will enable the county department of health to provide comprehensive reports on national and international commitments too. To enable the county government to effectively co-ordinate M&E activities, the department of health has identified and sensitised staff and stakeholders on the institutional and individual capacities required to support the M&E functions. At the institutional level, the CHSSP proposes the creation of a division that is responsible for planning, monitoring, and evaluation, under which the unit responsible for coordinating M&E functions for the health department will fall. The division is expected to accord the necessary linkages with the key programs for health services (curative and preventive and rehabilitative) as well as the planning unit for the county government. The roles and responsibilities for the M&E unit are summarised in Table 4.1 32 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Roles and Responsibilities of Health Department’s M&E Unit • Coordinating the setting up the monitoring and evaluation system for health with focus on de- veloping work plan and budget for monitoring and evaluation activities • Collect, compile relevant M&E information • Establish and maintain a database of health outcome measures • Establish and maintain functional linkages with other relevant partners involved in county health M&E, including the national Ministry of Health, other County departments and sectors • Analyze and interpret programmatic as well as outcome and impact data • Prepare and regularly update the county health profile • Provide feedback; prepare quarterly monitoring reports and annual health reports and reviews • Develop capacity at the sub county level in M&E • Serve as the Secretariat of the M&E Technical Working Group (TWG) that coordinates M&E within the County Health Sector. • reviewing and providing feedback to programmes on the quality of methodologies established to collect monitoring data • preparing consolidated progress reports for the County Health Stakeholders Forum The County Department for Health Services will strengthen the current M&E unit within the department to enable it to support coordination of the county health M&E functions. In proposing a suitable structure for the M&E unit, the county government has considered the need to ensure close linkages with the highest decision making organs, need to build a blend of skills necessary for delivery of the functions and build-up of a functional M&E system as well as providing opportunities for career development; and close collaboration with the County planning unit with a bid to feed appropriately into the County Integrated Monitoring and Evaluation System (CIMES). The proposed structure is presented below: 4.1.2 Linkage with stakeholders To accord effective participating of stakeholders and partners in the delivery of health M&E functions, the county health sector will strengthen and utilise the Monitoring and Evaluation TWG. The M&E TWG will be reconstituted and its capacity needs identified, and support sought to fill in gaps from the partners closely working with the county health department. The M&E TWG shall share its reports with the County Health Stakeholder Forum through its Steering/Coordination Committee. Table 4.2 outlines the functions of the county M&E TWG for health services. 33 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Strategic Information and research Key functions of M&E TWG • Supporting coordination/harmonization of M&E activities (data collection, analysis, dissemina- tion) among the MOH and the partners. • Identifying and prioritizing critical action steps for county, Sub-County and Facility M&E work to assure that action is taken by the relevant group(s) to achieve quality M&E in a timely fashion. • Promote operational research to support evidence-based, efficient programme implementa- tion and the use of M&E tools. • Identifying and recommending strategies for addressing the needs for capacity building in M&E at all levels. • Developing and maintaining consensus around M&E strategies across county department of health and partners. • Developing and providing technical guidance on selection and definition of indicators for county health reporting. • Providing technical guidance on appropriate data collection methods, analytic strategies, and dissemination of recommendations. • Monitoring changing needs in health M&E arena. 4.2 Operational Guidelines and Tools for County Health M&E Implementation of this M&E Plan requires the county department of health to put in place various guidelines, standard operating procedures and protocols for data management, data quality assurance, data analysis and synthesis, and data dissemination. During the implementation of the CHSSP 2018-2022, the county government will formulate guidelines (or adopt the national ones where they are in existence) and follow up on implementation. This plan acknowledges the role of the national government in setting policies, standards and regulation; and therefore, the existence of various standards. The county government will disseminate the standards and guidelines to the decentralized structures and support their implementation. These guidelines include amongst others: National M&E Framework, Monitoring and Evaluation Institutionalization Guidelines, Health Information System Policy, Indicators Manual and SOP, Data Quality Assurance Protocol, and the Kenya Health Enterprise Architecture. This plan envisages that the county health department will need to develop SOPs for data collection, data collation and reporting; data cleaning and validation, evaluations, survey and research, performance review, data review, and data dissemination. With regards to the tools supporting the implementation of the above SOPs, the county will continue support the application of both manual and electronic tools at the appropriate levels of the healthcare system. 4.3 Dissemination of Information and Information Products Data need to be translated into information that is relevant for decision-making. Data will be packaged and disseminated in formats that are determined by management at the various levels. Service delivery data shall be packaged and displayed at various health facilities using the HMIS formats and designed non-HMIS formats. The timing of information dissemination will be scheduled to fit in the planning cycles and needs of the users. 34 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) County health information will be disseminated through reports (electronic and print) to stakeholders, presentations and workshops, annual health review meetings, media briefs international health days, publications, websites and other documentation. • Quarterly and Annual Health Statistical Reports and Bulletins • Quarterly Performance Review meetings and Reports • Annual Performance Review • Dissemination of Survey Findings: Feedback on survey findings will be in form of workshops and dissemination of reports which will be circulated to relevant stakeholders in hard copy as well as on the county website 4.4 Key Responsibilities for Samburu Health Sector M&E To be successful, M&E functions need to be carried out by the respective programmes and at all levels of health care delivery, from the national to the community level. The following section outlines the key responsibilities of various units under which M&E functions fall at the national and county level. 35 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 36 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Table 8: Key Responsibilities and functions of the M&E unit Stewardship Goal National level County Level: CHMT Sub-County Level: County Level: Partners Facility level Community SCHMT level Establishment of • Define standards for • Conduct oversight • Conduct oversight • Support the counties • Maintain and update • Community a common data data sharing between to manage all to manage all in establishing data the Health Information Units: Maintain architecture aggregate and patient- monitoring, monitoring, evaluation collection structures. System, including and update its level data. evaluation and and research data records, filing system(s) M&E, which research data from from all programmes • Work collaboratively and registry for shall be shared • Coordinate development all programmes within their area of with the MoH M&E primary data collection regularly with of minimum data sets within their area of jurisdiction. Unit to provide data, tools (such as registers, household and data requirements of jurisdiction. as appropriate, on cards, file folders), members in a the health sector. • Compile all reports population-based and summary forms forum as stated • Create and maintain from the Sub county statistics, and vital (such as reporting in the relevant • Create and maintain a monitoring system health facilities into events (births and forms, CDs, electronic community a data repository of and data repository. a single sub-County deaths), and health backups). strategy. health and health related Health report. related research data information. • Collaborate and for comparative analysis • Safeguard data and • Community work in partnership and warehousing. information system health workers: • Carry out oversight with other statistical from any risks, e.g., Maintain registers functions to manage constituencies at the fire, floods, access by to document all health and health- county level to build unauthorized persons. daily activities related data from one county-wide M&E and report service providers at all system based on the • Compile all reports regularly to levels to inform policy principles outlined in from the Technical supervising formulation. this document. Officers into a single health facility. health facility report. Compile all • Compile all reports reports from the from the Sub counties CHW into a single County Health report. 37 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Stewardship Goal National level County Level: CHMT Sub-County Level: County Level: Partners Facility level Community SCHMT level Improve performance • Aggregate, analyse, • Produce a health • Produce a health • Work within the health • Ensure compilation • Develop and review processes disseminate and use sector performance sector performance sector M&E framework and processing of quarterly health and health-related report that includes report that includes and guidelines and minutes, inventory, and annual data on the performance service delivery service delivery meet the reporting supervision and other community of the health sector metrics. metrics. requirements as defined activity reports. health reports for priorities outlined in the by minimum datasets. integration into KHSSP from all • Analyse the quality • Analyse the quality of • Analyse the quality facility reports. of all reports all reports received and of all reports • MoH departments, received and ensure appropriate received from SAGAs, national ensure appropriate follow-up in case of various health facility hospitals, CHMTs and follow-up in case incompleteness or units and ensure others, and provide of incompleteness problems with validity, follow-up in case feedback to all. or problems with as well as delays from of incompleteness, validity, as well as the facilities problems with validity, • Compile all reports at delays from the Sub or delays the national level on county levels. • Collate, analyse, performance tracking of disseminate and use the strategic plan. • Provide technical, health and health- material and financial related data from all • Analyse the quality of support for M&E to all Sub county facilities all reports received and sub counties. and give feedback ensure follow-up in case of incompleteness, • Collate, analyse, problems with validity, disseminate and use and delays. health and health- related data from all • Provide technical Sub county offices support to all national- and give feedback level operational units, SAGAs, and national referral hospitals in monitoring and evaluation. 38 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Stewardship Goal National level County Level: CHMT Sub-County Level: County Level: Partners Facility level Community SCHMT level Enhancing sharing of • Develop M&E-related • Ensure proper • Ensure proper • Provide support to • Ensure that every • Forward the data and promoting guidelines and policies. information flow information flow strengthen the MoH health facility committee report use of information for from various levels from health facilities M&E Unit in their areas summarises health to the facility In- decision-making • Prepare and disseminate to inform policy and community of operation (e.g., and health-related Charge. national annual and formulation, health units to inform through provision of data from the quarterly performance guidelines, and policy formulation, technical support and community and health • Provide quarterly review reports. development of guidelines, and capacity building). facility; analyses it; feedback to the protocols, and to development of disseminates it and community unit. • Ensure proper address country’s protocols in the sub uses the information information flow international counties. for decision-making; • Disseminate from various levels in obligations. (This provides feedback; and quarterly accordance with national specifically includes • Prepare data analyses transmits summaries reports to the and international forwarding the for discussion during to the next level. community unit. data and reporting County Health report the directorate obligations. (This • Disseminate to the National MoH.) meetings, the County • Prepare an analysis of includes, specifically, M&E congress and the data for discussion annual report to forwarding Country • Prepare data analyses other forum for during staff and board the community Health information as for discussion during decision making meetings for decision- unit. required to the Director the CECM and making. for Health for forwarding directorate meetings forwarding the Sub- to international actors.) and forum for County Health report • Forward health and decision-making. to the County Director health-related reports • Provide capacity- for Health. to the Sub county building in M&E. • Develop County level. Health report and • Prepare and share the share with the CECM • Provide quarterly Annual State of Health feedback to the reports during the Health • Develop quarterly health providers and Congress. feedback to the CECM the community unit and County Director committee. for Health and share with them. • Disseminate quarterly reports to the health • Disseminate quarterly facility committee. reports to Sub county health teams and • Disseminate annual Health Committee. report to the health facility committee and Sub county forum 4.5 Monitoring & Evaluation Implementation Framework The key M&E interventions during the period 2018-2022 is tabulated below with the associated budget estimates Table 10: Monitoring & Evaluation Budget Yr Total Yr 1 Yr 2 Yr3 Yr4       5   Domain/ Responsible Key interventions Activity Indicator Target Budget Category Person(s) Define the mandate and structure of the M&E Unit structure 1    X         COH County Health M&E defined unit Create a strategy concept document Number of strategy for the establishment concept document 1    X         CDH M&E Unit of the County Health created. M&E Unit Develop a resource Number of resource mobilization plan for mobilization plan 1  500,000  X         CDH a fully functional M&E developed unit Establish of a fully Fully functional M&E 1  2,000,000  X  X       COH functional M&E unit Unit Review and update Number of staffing the staffing plan to plan reviewed, and    650,000    X       Head M&E include the M&E unit M&E included. Undertake a training Number of Policy and needs assessment for 1  300,000   X       Head M&E assessments done Planning MLA Develop Job Number of M&E Descriptions for the job description 1  200,000    X       CDH staff dedicated to developed M&E Develop a capacity Number of existing building plan for the staff capacity build  1     X        Head M&E existing staff to take on M&E up M&E roles Recruit additional ( at least 3 )staff with Number of M&E staffs  3  4,000,000   X  X     COH M&E Unit the relevant M&E recruited Staffing qualifications. Review and adopt the National DQA DQA Protocols 1  300,000    X       Head M&E protocol Disseminate and Number of staff sensitize the staff on sensitized on DQA  300  800,000    X  X     CDH the DQA protocol protocols Develop SOPs for Data Management Aligned Data 1  500,000    X  X     CDH Data aligned to the DQA management SOPs. Standards protocol 39 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Yr Total Yr 1 Yr 2 Yr3 Yr4       5   Domain/ Responsible Key interventions Activity Indicator Target Budget Category Person(s) Conduct a mapping, assessment and costing of the current status of the ICT Assessment report 1  200,000  X         CDH infrastructure in the health department. (Loop in the county ICT officer) . Develop a county County repository (website) County M&E Databases 1  100,000    X       CDH for information repository website. products access Develop dashboard that can easily be accessed by the Information products relevant stakeholders 1  200,000    X       Head M&E Dashboard as an information product for sharing health data Routine Develop and adopt Best practice Monitoring guidelines for best guidelines developed 1  500,000    X       Head M&E practices in data and adopted management. Number of staffs Sensitize the staff on sensitized on data CHRIO/Head the guidelines for 500  1,200,000      X     management M&E data management guidelines Advocate for budget for printing of the missing MOH tools % of MOH tools 100  10,000,000  X X  X  X  X CHRIO from the county printed. and implementing partners Sensitize and train staff on the Number of staffs Samburu County sensitized on  50  1,500,000    X       COH health department performance performance contract contracts reviews. Review, update, % of staff sensitized HRH disseminate the staff on revised appraisal  100%  2,100,000    X  X     Coordinator appraisal forms forms 40 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Yr Total Yr 1 Yr 2 Yr3 Yr4       5   Domain/ Responsible Key interventions Activity Indicator Target Budget Category Person(s) Conduct monthly facility and quarterly Number of review  20  2,000,000  X  X X  X  X Head M&E subcounty data meetings conducted review meetings Conduct quarterly Number of RDQAs RDQAs with action with action plan  50  3,500,000  X X  X  X  X Head M&E plans for follow-up developed Routine Conduct follow-up Quarterly supervision Data Quality support supervision  60  6,000,000  X X  X  X  X CHRIO conducted Assurance for facilities Capacity build the county leadership, CHMT, SCHMT and High-volume Data facility in charges on Number of staffs Analysis and data analytics and trained on data Dissemination visualization analytics  45  3,600,000    X  X  X  X  CDH Perform periodic Number of evaluations on Evaluations  M&E Evaluation program outcomes undertaken  8  3,200,000    X  X  X  X Coordinator Support Scale up implementation of Number of EMRs the EMR to all high- installed in high volume facilities volume facilities  5  2,000,000    X  X      CDH Sensitization of the Number of CHMT/ CHMT and SCHMT SCHMT and facility in and facility in charges charges trained on on DHIS2 DHIS2  32  1,600,000    X  X      CHRIO Number of HRIOs Support HRIOs with supported with data data bundles bundles  8  3,000,000  X  X  X  X  X  COH Conduct regular(quarterly) Number of M& E TWG  M&E M&E TWG meetings. Meetings Conducted  20  2,000,000  X  X  X  X  X Coordinator Develop ToR for all Number of TWGs thematic TWGs with ToR developed  5  250,000    X  X    CDH County Create a schedule of Number of TWGs with Coordination activities ( Annual activities schedules Body Plan) for the TWGs. approved  5      X  X      CDH 41 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Yr Total Yr 1 Yr 2 Yr3 Yr4       5   Domain/ Responsible Key interventions Activity Indicator Target Budget Category Person(s) Establish a county editorial team including health staff Number of editorial and partners team established  1      X        COH Capacity build the editorial team and Number of editorial program officers team and program on development of officer’s capacity information products build  1  300,000    X        COH Develop information products (county fact sheet, county M&E Technical health factsheet) and Number of Working publish on quarterly information products Group basis developed  4  3,000,000  X  X  X  X  X  CDH Conduct quarterly performance reviews of the M&E system and communicate the findings to health Number of quarterly Internal staff at sub county performance review Coordination and facilities. conducted  20  4,000,000  X  X X  X  X  CDH 59,410,000 42 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Chapter 5: Evaluation Plan 5.1 Introduction The evaluation plan describes what will be evaluated, how and when. The evaluation endeavors to look at the overall project/ interventions in terms of the operations, governance, deliverables, and hence assist the County Health Management Team and partners to learn and make improvements. The information obtained helps in planning, designing/redesigning and developing health sector interventions that are relevant, effective, efficient, sustainable and impactful. 5.2 What will be evaluated? i) Relevance (measure use of resources and the process used to obtain the results): The extent to which the interventions are suited to the priorities of the target group. ii) Effectiveness (measures results – health outcomes): A measure of the extent to which the health department will attain its six priority objectives. These objectives include: • Eliminate Communicable Conditions • Halt, and or reverse the rising burden of non-communicable conditions • Reduce the burden of violence and injuries • Minimize exposure to health risk factors • Provide essential health services • Strengthen collaboration with health-related sectors In answering questions to measure effectiveness (Table 11), the evaluation will track indicators for each of the objectives listed in Annexes 3 and 4. iii) Efficiency: Efficiency measures the outputs in relation to the inputs. This signifies that the county health sector uses the least costly resources possible in order to achieve the desired results. iv) Impact: The positive and negative changes produced by health interventions, directly or indirectly, intended or unintended. This involves the main impacts and effects resulting from the implementation of interventions on health indicators (refer to Annexes 3 and 4). v) Sustainability: Sustainability is concerned with measuring whether the benefits of the health programme interventions are likely to continue after external funding has been withdrawn or ceased. Interventions or projects need to be environmentally and financially sustainable. vi) Innovations: Monitoring innovations aims to assess the functioning and effectiveness of innovation platforms to improve policy and practice, develop capacity and improve links among actors. The information it gathers will be used to improve the management of the platform and its activities, change policies, and promote larger scale changes. The three aspects of innovation platforms to be monitored will be: • Activities that aim to resolve a problem or take advantage of an opportunity. They may include technologies, methods and approaches, policies, empirical evidences or other tangible products. Monitoring activities will make it possible to track progress, provide feedback and improve performance. • Process outputs include changes in knowledge, attitudes and practices of the platform members and the organizations or groups they represent, and the relationships amongst them. Monitoring process outcomes gives an understanding of how the innovation platform changes the knowledge, attitudes and practices of individuals and the links between them. • Results of the impacts on target beneficiaries. Monitoring results provides quantitative and qualitative evidence of the platform’s work and allows it to be compared with other approaches. 43 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Table 11: Evaluation Plan What to Measure Evaluation Questions Method to answer the Frequency Responsible Questions Person Relevance • How well was the health • Monitoring system • Baseline (2017) County M&E programme designed, planned, that tracks actions and • Annual Coordinator and how well was that plan accomplishments related • Midterm (2021) implemented? to bringing about the • End term (2023) • To what extent are the mission of the initiative objectives of the health (activity) programme still valid? • Survey on satisfaction • Are the activities and outputs with goals (Client of the health programme satisfaction survey) consistent with the overall • Survey on satisfaction goal and the attainment of its with outcomes (Provider objectives? satisfaction survey) • Are the activities and outputs of the programme consistent with the intended impacts and effects? Effectiveness • To what extent were the • Monitoring system • Baseline (2017) County M&E objectives achieved / are likely that tracks actions • Annual Coordinator to be achieved? and accomplishments • Midterm (2021) • What were the major factors related to bringing influencing the achievement about the mission of the • End term (2023) or non-achievement of the interventions (activities) objectives? • Behavioural surveys (primary and secondary data sources) • Interviews with key informants Efficiency • Were activities cost-efficient? • Cost-effectiveness analysis • Baseline (2017) County M&E • Were objectives achieved on • Annual Coordinator time? • Midterm (2021) • Was the health programme • End term (2023) implemented in the most efficient way compared to alternatives? 44 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) What to Measure Evaluation Questions Method to answer the Frequency Responsible Questions Person Impact • What resulted from the health • Behavioural surveys • Baseline (2017) County M&E programme? (primary and secondary Coordinator • How has behaviour changed as data sources) • End term (2023) a result of participation in the • Interviews with key program? informants • Are participants satisfied with the experience? • Were there any negative results from participation in the program? • Were there any negative results from the program? • How many people have been affected? • Do the benefits of the program outweigh the costs? Sustainability • To what extent did the benefits • Monitoring system • Baseline (2017) County M&E of the programme or project that tracks actions and • Midterm (2021) Coordinator continue after donor funding accomplishments related • End term (2023) ceased? to bringing about the mission of the initiative • What were the major (activity) factors which influenced the achievement or non- • Behavioural surveys achievement of sustainability (primary and secondary of the programme or project? data sources) • Interviews with key informants 45 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 1: Indicator Definition Manual Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) Life expectancy at birth Life expectancy at birth is defined as the Vital registration; Census Five years Head, M&E unit average number of years that a new-born and surveys: Age -specific could expect to live if he or she were mortality rates required to to pass through life subject to the age- compute life expectancy specific mortality rates of a given period. at birth. Total annual number The number of deaths in general Scaled to the size of that Five years Head, M&E unit of deaths (per 100,000 population population, per unit of population) time. Mortality rate is typically expressed in units of deaths per 100,000 individuals per year Maternal deaths per Number of maternal deaths per 100 000 Vital registration; KDHS; Five years Head, M&E unit 100,000 live births live births during a specified time period, census; health service usually one year. records Neonatal deaths per Number of deaths during the first 28 Vital registration; KDHS Five years Head, M&E unit 1,000 live births completed days of life per 1 000 live births in a given year or period. Under five deaths per Under-five mortality rate is the Civil registration; Census; Five years Head, M&E unit 1,000 probability of a child born in a specific KDHS year or period dying before reaching the age of five, if subject to age - specific mortality rates of that period Youth and Adolescent Deaths among young people aged Vital registration; KDHS; Five years Head, M&E unit deaths per 1,000 10–24 years Census; health service records Adult deaths per 1,000 Deaths among adults aged above 25 Vital registration; KDHS; Five years Head, M&E unit years Census; health service records Elderly deaths per 1,000 Deaths among adults aged above 60 Vital registration; KDHS; Five years Head, M&E unit years Census; health service records Years of life lived with The sum of years of potential life lost due Vital registration; KDHS; Head, M&E unit illness / disability to premature mortality and the years of Census productive life lost due to disability Proportion (%) of fully N: Number of children under the age DHIS-MOH 710; MOH 510; Monthly/ Head, Family Health immunized of 1 who received 3 doses of Oral Polio MOH 702; Surveys; KNBS Quarterly/ Vaccine (OPV), 3 doses of pentavalent, Children and 1 dose each of Bacilli Chalmette- Annually Guerin (BCG) and measles vaccine (static and outreach), 3 doses pneumococcal vaccine and 3 doses of rotavirus before the age of 12 months D: Estimated number of children younger than one year in a given period Proportion (%) of N: Number of people receiving MDA MOH 517; DHIS; Surveys; Monthly/ Head, Preventive/Promotive target population Reports receiving mass drug D: Number of people at risk of Trachoma Quarterly/ administration (MDA) for in the county. Annually Trachoma Proportion (%) of TB N: Number of patients who completed TB treatment register; DHIS Monthly Head, Preventive/Promotive patients completing TB treatment - MOH 711 treatment D: All TB cases recorded in the TB registers (within the assessed cohort period) 46 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 1: Indicator Definition Manual Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) Proportion (%) of HIV+ N: Number of pregnant women living MOH 405,333,406; DHIS – Monthly Head, Preventive/Promotive Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) pregnant with HIV/AIDS who received antiretroviral MOH 711,731 medicines Life expectancy at birth Life expectancy at birth is defined as the Vital registration; Census Five years Head, M&E unit women receiving average number of years that a new-born and surveys: Age -specific (PMTCT) preventive D: Number of pregnant women living could expect to live if he or she were mortality rates required to ARVs with HIV/AIDS to pass through life subject to the age- compute life expectancy Proportion (%) of N: Number of HIV+ adults and children MOH 361B; DHIS- MOH Monthly Head, Preventive/Promotive specific mortality rates of a given period. at birth. eligible HIV clients on who are eligible for ARVs and are 731, 711; KAIS Total annual number The number of deaths in general Scaled to the size of that Five years Head, M&E unit ARVs currently receiving ARVs therapy at the of deaths (per 100,000 population population, per unit of end of the reporting period population) time. Mortality rate is typically expressed in units D: Estimated number of HIV+ adults and of deaths per 100,000 children eligible for ARVs individuals per year Proportion (%) of under- N: Number of under-5s treated for MOH 204 A; DHIS - MOH Monthly Head, Family Health Maternal deaths per Number of maternal deaths per 100 000 Vital registration; KDHS; Five years Head, M&E unit 5s treated for diarrheal diarrheal 705 A 100,000 live births live births during a specified time period, census; health service usually one year. records D: Number of under-5ss with diarrheal Neonatal deaths per Number of deaths during the first 28 Vital registration; KDHS Five years Head, M&E unit % of school age children N: Number of de-wormed school-age DHIS – MOH 517; Surveys; Biannual Head, Family Health 1,000 live births completed days of life per 1 000 live de-wormed children Reports births in a given year or period. Under five deaths per Under-five mortality rate is the Civil registration; Census; Five years Head, M&E unit D: Total number of children aged 2-14 1,000 probability of a child born in a specific KDHS years year or period dying before reaching the % of children aged 12- N: Number of de-wormed children aged DHIS - MOH 517 Monthly Head, Family Health age of five, if subject to age - specific 59 months de-wormed 12-59 months mortality rates of that period D: Total number of children aged 12-59 Youth and Adolescent Deaths among young people aged Vital registration; KDHS; Five years Head, M&E unit months in the catchment area deaths per 1,000 10–24 years Census; health service records Proportion (%) of adult N: Total number of adults with BMI over Survey After every Head Preventive & population with BMI 25 2 Yrs. Promotion Adult deaths per 1,000 Deaths among adults aged above 25 Vital registration; KDHS; Five years Head, M&E unit over 25 years Census; health service D: Total adult population in the area records Proportion (%) of N: Number of women of reproductive MOH 405, MOH 406; Monthly Head, Family Health Elderly deaths per 1,000 Deaths among adults aged above 60 Vital registration; KDHS; Five years Head, M&E unit women of reproductive age screened for cervical cancer Family planning, Cervical years Census; health service age screened for cervical cancer service register; records cancer D: Estimated number of women of MOH 204B Years of life lived with The sum of years of potential life lost due Vital registration; KDHS; Head, M&E unit reproductive age illness / disability to premature mortality and the years of Census Proportion (%) of new N: Number of new outpatients with Outpatient Registers MOH Monthly Head, Curative productive life lost due to disability outpatients with mental mental health conditions Proportion (%) of fully N: Number of children under the age DHIS-MOH 710; MOH 510; Monthly/ Head, Family Health health conditions 204A & 204B; DHIS – MOH immunized of 1 who received 3 doses of Oral Polio MOH 702; Surveys; KNBS Quarterly/ D: Total number of all newly diagnosed 705A, MOH 705B Vaccine (OPV), 3 doses of pentavalent, cases Children and 1 dose each of Bacilli Chalmette- Annually Proportion (%) of new N: Number of cases diagnosed with MOH 204B; DHIS – MOH Monthly Head, Curative Guerin (BCG) and measles vaccine (static outpatient cases with hypertension in a month 705B and outreach), 3 doses pneumococcal high blood pressure vaccine and 3 doses of rotavirus before D: Total number of all newly diagnosed the age of 12 months cases (for all diseases) in a month D: Estimated number of children younger % of patients admitted N: Number of cancer patients admitted Hospice records; MOH 301 Monthly Head, Curative than one year in a given period with cancer D: Total number of cases admitted in a DHIS – Inpatient Morbidity Proportion (%) of N: Number of people receiving MDA MOH 517; DHIS; Surveys; Monthly/ Head, Preventive/Promotive month and Mortality Report target population Reports receiving mass drug D: Number of people at risk of Trachoma Quarterly/ Proportion (%) of N: Number of new gender-based MOH 363- Post Rape Care Monthly Reproductive health focal administration (MDA) for in the county. Annually new outpatient cases violence cases treated in outpatient person Trachoma attributed to gender- Register; DHIS- 364 Sexual based violence D: Total number of outpatients in a Gender Proportion (%) of TB N: Number of patients who completed TB treatment register; DHIS Monthly Head, Preventive/Promotive month patients completing TB treatment - MOH 711 Based Summary Form treatment D: All TB cases recorded in the TB registers (within the assessed cohort period) 47 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) Proportion (%) of N: Number of new outpatient cases OPD register MOH 204A, Monthly Outpatient Department new outpatient cases attributed to road traffic accidents MOH 204B; DHIS -705A, (OPD) in-charge attributed to road traffic MOH 705B accident Injuries D: Total number of outpatients in a month Proportion (%) of N: Number of new injuries other than OPD register MOH 204B, Monthly Outpatient Department new outpatient cases those caused by road traffic accidents 204A; MOH 301, MOH 268; in-charge attributed to other seen in outpatient DHIS -705A,705B injuries D: Total number of outpatients in a month Proportion (%) of facility N: Number of deaths due to injuries OPD register MOH 204B, Monthly Hospital/Facility in-charge deaths due to injuries reported in a facility 204A; MOH 301, MOH 268; DHIS -705B,705A and D: Total number of institutional deaths in Inpatient Morbidity and a month Mortality; Report Mortuary Records *Per capita outpatient N: Number of visits to outpatient facility Outpatient registers MOH Yearly Facility in-charge utilization rate (m/f ) for ambulant care per year 204A, MOH 204B; DHIS - MOH 717 D: Total population in the area Proportion (%) of N: Total population living within 5 km Survey Every five Head, Planning and Policy population living within radius of a health facility years 5 km of a health facility D: Total population in the health facility’s catchment area Proportion (%) of N: Total number of level 2-6 facilities Rapid health facility Annually Head, Planning and Policy facilities providing providing BEmONC surveys; Updated Master BEmONC Facility List (MFL) D: Total number of level 2-6 facilities in the area Proportion (%) of N: Number of level 4-6 health facilities Rapid health facility Annually Head, Planning and Policy facilities providing providing CEmONC surveys; Updated Master CEmONC Facility List (MFL) D: Total number of level 4-6 health facilities in the catchment area surveyed Bed occupancy rate N: Number of patient bed days (X 100) MOH 301; Daily bed Daily/ Head, Planning and Policy returns; DHIS – MOH 717 Monthly/ D: Number of beds in institution X Number of days in time period under Annually review Proportion (%) of N: Number of level 2-5 health facilities Rapid health facility Annually Head, Planning and Policy facilities providing providing immunization services surveys; Updated Master immunization services Facility List (MFL) D: Total level 2-5 health facilities level in the area Proportion (%) of N: Number of deliveries conducted by MOH 333; DHIS – MOH Monthly Facility in-charge, M&E Unit deliveries conducted by skilled personnel 711, MOH 717, skilled attendant D: Total number of expected deliveries KNBS projection Proportion (%) of N: Number of women receiving family MOH 512; DHIS – MOH Monthly Facility in-charge, M&E Unit women of reproductive planning services 711, MOH 717; KNBS age receiving family projection planning services D: Total number of women of reproductive age Proportion (%) of N: Number of maternal deaths occurring MOH 333; DHIS – MOH Monthly Facility in-charge, M&E Unit facility- based maternal at the facility 711; KNBS projection deaths D: Total number of expected deliveries 48 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) Proportion (%) of N: Number of under-five deaths MOH 511, MOH 301, MOH Monthly Facility in-charge, M&E Unit facility- based under-five occurring at the facility 204A; DHIS – Inpatient deaths Morbidity and Mortality D: Total number of children under the Report; KNBS projection age of 5 Proportion (%) of new- N: Number of new-borns with less than MOH 333; DHIS – MOH Monthly Facility in-charge, M&E Unit borns with low birth 2.5kg body weight 105 weight D: Actual number of live births whose birth weights were measured Proportion (%) of N: Number of fresh still births MOH 333; DHIS – MOH Monthly Facility in-charge, M&E Unit facility- based fresh still 717 births D: Total number of deliveries conducted Monthly Surgical rate for cold N: Cold surgical cases Theatre register; MOH 105; Facility in Charge, M&E Unit cases KNBS projection D: Total catchment population Proportion (%) of N: Number of women making 4th ANC MOH 406; MOH 105; Monthly Facility in-charge, M&E Unit pregnant women visit DHIS – MOH 711; KNBS making 4 ANC visits projection D: Total number of pregnant women Proportion (%) of N: Number of people who report that KDHS or other survey Annually CDH population who smoke they smoke regularly and who report that they had smoked in the preceding 24 hours of the interview (KDHS) D: Total number of persons interviewed in the survey Proportion (%) of N: Number of people who report that KDHS or other survey Annually CDH population consuming they consume alcohol regularly alcohol regularly D: Total number of people sampled in KDHS or other surveys Proportion (%) of N: Number of infants who are exclusively MOH 704; MOH 713; MOH Monthly Facility in-charge, M&E Unit infants under the age breastfed up to the age of 6 months 511; MOH 216 of 6 months who are exclusively breastfed D: Number of infants aged less than 6 months attending a child welfare clinic in a month Proportion (%) of N: Number of people in the survey who KDHS or other survey Annually CDH population aware of are aware of health risk factors health risk factors to health D: Total number of people sampled in KDHS or other surveys Proportion (%) of N: Number of salt brands that are KEBS, nutrition and public Yearly M&E Unit salt brands that are adequately iodized adequately iodized health D: All salt brands available in the market Couple year protection N: Number of sampled couples using MOH 711 Monthly Reproductive health focal condoms person D: Total number of couples in the survey % population with N: Total population with treated safe MOH515 Annually County Public Health access to safe water drinking water source Officer D: Estimated population in the area/ urban/rural 49 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) % under-5s stunted N: Number of children under 5 years MOH 713 Monthly County Nutrition Officer attending CWC who fall below minus 2 SD from the median height for age of WHO child growth standards D: Total number of children under 5 years measured % under-5s N: Number of children under 5 years MOH 713 Monthly County Public Health underweight attending CWC during the month/survey Officer with weight for age below 2SD D: Total number of children under 5 years weighed in CWC during the month School enrolment rate N: Number of children enrolled in School register Annually County Public Health primary and secondary schools Officer, County Department of Education D: Estimated population of school children to be enrolled in every level % of households with N: Number of households that use an MOH 515 Annually County Public Health latrines improved sanitation facility, urban/rural Officer D: Estimated households in urban and rural areas Proportion (%) of N: Number of urban/rural households Household survey; Biannually County Public Health households with with adequate ventilation administrative reporting Officer adequate ventilation system D: Estimated total number of households in the urban/rural area Proportion (%) of N: Number of primary and secondary MOH 708 Monthly County Public Health schools providing schools providing complete school Officer, County Department complete school health health package of Education package D: Total number of primary and secondary schools TB cure rate D: Number of TB patients with negative TB register Monthly TB Coordinator smear results at the end of 6 months of treatment N: Total number of TB patients with positive smear results at the start of treatment Proportion (%) of N: Number of positive malaria slide/RDT MOH 240- Laboratory Monthly Laboratory Coordinator patients with fever results at treatment’s initiation register who tested positive for malaria D: Number of patients tested for malaria Proportion (%) of N: Number of maternal death records DHIS – MOH 105; Monthly RH Coordinator maternal audits/ review Maternal Death Review Form death audits D: Total number of maternal deaths reported Malaria inpatient case N: Number of inpatients who died from MOH 301, MOH 268; DHIS- Monthly Facility in charges fatality malaria (per 1,000) Inpatient Morbidity and Mortality Report D: Total number of patient deaths plus discharges due to malaria 50 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Indicator Numerator (N), Denominator (D) Data source Frequency Responsible person(s) Average length of stay N: Inpatient days plus half-day patients MOH 717, MOH 268, 718; Monthly Facility in-charge (ALOS) DHIS- Inpatient Morbidity D: Inpatient discharge plus deaths and Mortality Report Proportion (%) of N: Number of children issued with birth B1, MOH 333 Monthly Facility in-charge children registered for notification birth notification (B1) D: Total number of births Number of Community N: Number of Community Units MOH 515 Monthly County Public Health Units established established Officer D: Total number of Community Units established Number of Community N: Number of Community Units DHIS 2 Monthly County Public Health Units reporting to DHIS reporting to DHIS Officer D: Total number of Community Units established Number of facilities N: Number of facilities reporting IDSR DHIS Monthly County Disease Surveillance reporting IDSR D: Total number of facilities Coordinator % of referrals initiation N: Number of referrals MOH 100 Monthly County Public Health D: Total number of clients seen Officer % of referrals received N: Number of referrals received MOH 100 Monthly County Public Health D: Total number of referrals initiated Officer % of referrals N: Number of referrals complete MOH 100 Monthly County Public Health completion D: Total number of referrals initiated Officer % of referrals counter N: Number of referrals counter-referred MOH 100 Monthly County Public Health referred D: Total number of referrals Officer Number of health N: Number of facilities reporting stock- LMIS Monthly County Pharmacist facilities reporting outs stock-outs of essential D: Total number of health facilities medicines % of health facilities N: Number of facilities reporting Health Facility Assessment Bi-annually County Public Health reporting improved improved QoC Officer quality of care services D: Total number of health facilities (QoC survey) Number of health N: Number of facilities with citizen Health Facility Assessment Bi-annually County Public Health facilities with citizen service charter Officer service charter D: Total number of health facilities % of intra-facility referral N: Number of intra-referrals initiated Health Facility Assessment Bi-annually County Public Health initiation D: Total number of referrals Officer % of intra-facility referral N: Number of intr- referrals completed Health Facility Assessment Bi-annually County Public Health completion D: Total number of intra referrals initiated Officer % of inter-facility N: Number of inter-facility counter- Health Facility Assessment Bi-annually County Public Health counter referrals referrals Officer D: Total number of inter-facility referrals Number of stakeholders N: Number of stakeholders actively Program Report Quarterly County Director for Health actively participating in participating the stakeholder forums D: Total number of stakeholders % of resources allocated N: Amount allocated to the health sector Budget Annually County Director for Health to the health sector D: Annual county budget 51 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 52 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 2: Data Management and Reporting Responsibilities Sno Available County Overall Sub county Overall Hospitals Primary Health Overall HF Reporting Reporting responsible(Action) responsibility Reporting responsibility Facility/ Responsibility Channel (Where Forms Person at county Channel at Sub-county Community at Health Applicable) Unit. Facility 1 CHEW Community Unit Focal County director of DHIS SCHRIO/ SCMOH CHEW CHEW Med Sup/In- Hardcopy/DHIS Summary person health. Charge 2 MoH 711 Reproductive County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator/ District health. HRIO In-Charge In-Charge Integrated Public Health Nurse (DPHN) 3 MoH 731-1 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge HIV CT MoH 731-2 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge PMTCT MoH 731-3 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge C&T MoH 731-4 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge VMC MoH 731-5 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge PEP MoH 731-6 County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge Blood Safety 4 HCBC County AID and STI County director of DHIS SCHRIO/ SCMOH Sectional in charge/ Facility Med Sup/ Hardcopy/DHIS Coordinator health. HRIO In-Charge In-Charge 5 IDSR Weekly District Disease County director of DHIS SCHRIO/ SCMOH Facility Facility Med Sup/ Hardcopy/DHIS Surveillance health. surveillance In-Charge In-Charge Coordinator(DDSC) focal person 6 Hospital County HRIO County director of DHIS SCHRIO/ SCMOH HRIO Med Sup/ Hardcopy/DHIS Administrative health. In-Charge Statistics (HAA). 53 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Sno Available County Overall Sub county Overall Hospitals Primary Health Overall HF Reporting Reporting responsible(Action) responsibility Reporting responsibility Facility/ Responsibility Channel (Where Forms Person at county Channel at Sub-county Community at Health Applicable) Unit. Facility 7 MoH 75 A County HRIO County director of DHIS SCHRIO/ SCMOH HRIO Facility Med Sup/ Hardcopy/DHIS health. In-Charge OPD <5 years In-Charge 8 MoH 75 B OPD County HRIO County director of DHIS SCHRIO/ SCMOH HRIO Facility Med Sup/ Hardcopy/DHIS health In-Charge >5 years In-Charge 9 MoH 717 County HRIO County director of DHIS SCHRIO/ SCMOH HRIO Facility Med Sup/ Hardcopy/DHIS health. Service In-Charge In-Charge Workload 10 MoH 718 County HRIO County director of DHIS SCHRIO/ SCMOH HRIO Facility Med Sup/ Hardcopy/DHIS health Inpatient M and M In-Charge In-Charge 11 MoH 710 County Public Health County director of DHIS SCHRIO/ SCMOH HRIO Facility Med Sup/ Nurse. health. Immunization In-Charge In-Charge Hardcopy/DHIS 12 MoH 706 Laboratory County Lab Coordinator County director of DHIS SCHRIO/ SCMOH Lab In-Charge Lab In-Charge. Med Sup/ Hardcopy/DHIS health. Report In-Charge 13 Support Supervision Chair CHMT County director of DHIS SCHRIO/ SCMOH Sectional In- Hardcopy/DHIS health. Charge/HRIO 14 IMAM County Nutritionist County director of DHIS SCHRIO/ SCMOH Nutritionist Facility Med Sup/ Hardcopy/DHIS health. In-Charge In-Charge 15 MoH 713 Nutrition County Nutritionist County director of DHIS SCHRIO/ SCMOH Nutritionist Facility Med Sup/ Hardcopy/DHIS health. Monthly Reporting. In-Charge In-Charge 54 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Sno Available County Overall Sub county Overall Hospitals Primary Health Overall HF Reporting Reporting responsible(Action) responsibility Reporting responsibility Facility/ Responsibility Channel (Where Forms Person at county Channel at Sub-county Community at Health Applicable) Unit. Facility 16 MoH 708 County Public Health County director of DHIS SCHRIO/ SCMOH PHT Public Health Med Sup/ Hardcopy/DHIS Officer. health. Environmental Officer/Public In-Charge Health Health Technician 17 Quarterly report County TB and Leprosy County director of DHIS SCHRIO/ SCMOH CO Tuberculosis Facility Med Sup/ Hardcopy/DHIS Coordinator. health. on Tuberculosis and Lung In-Charge In-Charge and Multiple Drug Resistant TB case-finding 18 Cohort Report County TB and Leprosy County director of DHIS SCHRIO/ SCMOH CO Tuberculosis Facility Med Sup/ Hardcopy/DHIS Coordinator. health for TB and Lung In-Charge In-Charge 19 HSSF Monthly County Accountant County director of DHIS SCHRIO/ SCMOH Facility Facility Med Sup/ Hardcopy/DHIS health. Expenditure accountant In-Charge In-Charge 20 HSSF summary County Accountant County director of DHIS SCHRIO/ SCMOH Facility Facility Med Sup/ Hardcopy/DHIS health. accountant In-Charge In-Charge 21 Malaria County Malaria County director of DHIS SCHRIO/ SCMOH Pharmacist Facility Med Sup/ Hardcopy/DHIS Commodities Coordinator. health. In-Charge In-Charge Form 22 Non- County Pharmacist. County director of DHIS SCHRIO/ SCMOH Nursing Officer In Facility Med Sup/ Hardcopy/DHIS health. charge Pharmaceutical In-Charge In-Charge 23 Division of County Occupational County director of DHIS SCHRIO/ SCMOH Occupational Facility Med Sup/ Hardcopy/DHIS health. Occupational Therapist Therapist In-Charge In-Charge 55 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Sno Available County Overall Sub county Overall Hospitals Primary Health Overall HF Reporting Reporting responsible(Action) responsibility Reporting responsibility Facility/ Responsibility Channel (Where Forms Person at county Channel at Sub-county Community at Health Applicable) Unit. Facility 24 Logistic Reproductive Health County director of DHIS SCHRIO/ SCMOH Pharmacist Facility Med Sup/ Hardcopy/DHIS health Management Coordinator/Sub county In-Charge In-Charge Information PHN 25 FP County Reproductive County director of DHIS SCHRIO/ SCMOH MCH In-Charge Facility Med Sup/ Hardcopy/DHIS Health. health. Contraceptives In-Charge In-Charge 26 Maternal Death County HRIO County director of DHIS SCHRIO/ SCMOH Maternity Facility Med Sup/ Hardcopy/DHIS health. Review Form In-Charge – In-Charge In-Charge Maternal Death review team. 27 Ophthalmology County County director of DHIS SCHRIO/ SCMOH Ophthalmologist. Facility Med Sup/ Hardcopy/DHIS health. Services Ophthalmologist In-Charge In-Charge 28 Orthopedic County Plaster County director of DHIS SCHRIO/ SCMOH Plaster Facility Med Sup/ Hardcopy/DHIS health Technologies. Plaster technologist In-Charge In-Charge Annex 3: County Key Indicators Targets Targeted trends Policy Objective Indicator Mid Term Target Baseline (2017/2018) (2020/2021 (2022/2023) IMPACT Life expectancy at birth 52 Total annual number of deaths (per 100,000 2*/1000 6/100,000 population) Maternal deaths per 100,000 live births 362*/100,000 Infant mortality rate per 1000 livebirths 34*/1000 Neonatal deaths per 1,000 live births 11/1000 Improve health outcomes Children under five years stunted 35/100 Under five deaths per 1,000 50/1000 5/100,000 Youth and Adolescent deaths per 1,000 TBD Adult deaths per 1,000 183*/1000 Elderly deaths per 1,000 TBD Years of life lived with illness / disability TBD Distribution of health % range of health services outcome index TBD Services responsiveness Client satisfaction index TBD HEALTH & RELATED SERVICE OUTCOME TARGETS % of fully immunized children 67% 88% 96% % of target population receiving MDA for Trachoma 81%(yr. 2015( 100% % of TB patients completing treatment 86% 100% 100% % HIV+ pregnant mothers receiving preventive ARVs 84% 100% 100% Eliminate communicable conditions % of HIV clients on ARVs 80% 87.5% 97% % of HIV+ clients virally suppressed 75% 85% 90% % of under-5s treated for diarrhoea 41% 26% 16% % children aged (12-59 months) dewormed 24.6% 39.6% 49.6% % of school age children de-wormed(6-14yrs) 24.6% 39.6% 49.6% % of adult population with BMI over 25 5% 2% 1% % of women of reproductive age screened for 0.05% 45% 75% cervical cancers % of new outpatients with mental health conditions 0.2% 0.2% 0.2% Halt, and reverse the % of new outpatient’s cases with high blood pressure 0.8% 0.5% 0.3% rising burden of non- % of patients admitted with cancer 5% 2% 1% communicable conditions % of under-five attending CWC for growth 53.4% 1% 1% monitoring (new cases) % of newly diagnosed diabetic patients 1.3% 0.875% 0.375% % of severely and moderately malnourished children 50% 37.5% 27.5% admitted % new outpatient cases attributed to gender-based 0.2% 0.15% 0.05% violence Reduce the burden of % new outpatient cases attributed to road traffic 0.3% 0.15% 0.05% violence and injuries Injuries % new outpatient cases attributed to other injuries 4.8% 1.8% 0.5% % of deaths due to injuries 0.004% 0.003% 0.002% 56 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Targeted trends Policy Objective Indicator Mid Term Target Baseline (2017/2018) (2020/2021 (2022/2023) % deliveries conducted by skilled attendants 37% 60% 70% % of women of reproductive age receiving family 33% 60% 70% planning services Provide essential health % of facility-based maternal deaths 0.02% 0.00% 0.00% services % of facility-based under-five deaths 0.05% 0.00% 0.00% % of new-borns with low birth weight 27.5% 12.5% 2.5% % of facility-based fresh still births 5.25% 0.0% 0.00% % of pregnant women attending 4 ANC sessions 27.4% 57.4% 77.4% % of population who smoke 14.3% 5.3% 1.3% Couple year protection due to condom use 41.9% 71.9% 91.9% % of population consuming alcohol regularly 27% 21% 17% % of infants aged under 6 months on exclusive 85% 91% 95% breastfeeding % of population aware of health risk factors 80% 80.3% 80.3% Minimize exposure to % of children (6-11 months) supplemented with Vit A 93% 95% 97.5% health risk factors % of children (12-59 months) supplemented with 50% 65% 85% Vit A % of lactating mothers supplemented with Vit A 75% 82.5% 92.5% % of pregnant women receiving IFAS 65% 69% 77.5% % of children (6-23months) supplemented with MNP 0% 65% 85% % of salt brands adequately iodized 100% 100% 100% % population with access to safe water 17% 48% 68% % under-5s stunted 35.8% 1.6% 1% % of under-5s underweight 21.5% 18.25% 12.5% Strengthen collaboration School enrolment rate 60% 75% 85% with health-related % of households with latrines 33.4% 48.4% 58.4% sectors % of houses with adequate ventilation 50.9% 65.9% 75.9% % of classified road networks in good condition 3% 6% 11.5% % of schools providing complete school health 2% 12.5% 27.5% package HEALTH INVESTMENT OUTPUT Improving access to Per capita outpatient utilization rate F=4.8 2 2 services M=3.9 1.2/0.98 % of population living within 5km of a facility 21.5% 51.5% 71.5% % of facilities providing BEmONC 35.8% 68.8% 88.8% % of facilities providing CEmONC 33% 83% 100% Bed occupancy rate 60% 75% 80% % of facilities providing immunization 65% 80% 90% Improving quality of care TB cure rate 85% 91% 95% % of fevers tested positive for malaria 31% 16% 10% % of maternal audits/death audits 50% 100% 100% Malaria inpatient case fatality 2% 1% 1% Average length of stay (ALOS) 4 days 3days 3days Health Input and Process Investment 57 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Targeted trends Policy Objective Indicator Mid Term Target Baseline (2017/2018) (2020/2021 (2022/2023) Service delivery systems % of functional community units 100 100 100 % of outbreaks investigated within 48 hours 100 100 100 % of hospitals offering emergency trauma services 100 % hospitals offering Caesarean sections 100 100 100 % of referred clients reaching referral unit 100 100 100 Health workforce # of nurses per 10,000 population TBD % of eligible staff who have undergone CPD 100 Staff attrition rate 1% 0.5% % of public health expenditure (government and TBD donor) spent on human resources % of facilities equipped as per norms 100% 100% # of hospital beds per 10,000 population TBD Health Infrastructure % of public health expenditure (government and TBD donor) spent on infrastructure Health products % of time out of stock for essential medicines and 0% 0% 0% medical supplies (EMMS) – days per month % of public health expenditure (government and TBD donor) spent on health products Health financing General government expenditure on health as % of 40% 40% the total government expenditure Total health expenditure as a percentage of GDP TBD Off-budget resources for health as % of total public TBD sector resources % of health expenditure reaching the end users TBD % of total health expenditure from out of pocket TBD Health leadership % of health facilities inspected annually 65 80 100 % of health facilities with functional boards / 75 85 100 committees % of county stakeholder forums held 100 100 100 % of facilities supervised 90 100 100 # of health research publications shared with 0 2 4 decision-makers Health Information # of sector quarterly reports produced and 4 4 4 disseminated % of facilities submitting timely, complete and 89 95 100 accurate information % of health facilities with DQA 89 100 100 % of public health expenditure (government and TBD - - donor) spent on health information Source: DHIS 2 Ministry of Heath ** Baseline data will be obtained where it does not exist, and the targets identified within the first year of the plan. These are indicated as TBD. 58 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 4: Service Outcome and Output Targets for the Achievement of County Objectives Objective Indicator Targets (where applicable) Baseline Yr. 1 Yr. 2 Yr. 3 Yr. 4 Yr. 5 2016/17 2018/2019 2019/2020 2020/2021 2021/2022 2022/2023 Eliminate % Fully immunized children 67 80 84 88 92 96 Communicable % of target population receiving 81(Year 84 84 90 95 100 Conditions MDA for trachoma 2015) % of TB patients completing 86 100 100 100 100 100 treatment % HIV + pregnant mothers 84 100 100 100 100 100 receiving preventive ARV’s(HAART) % of eligible HIV clients on ARV’s 100 100 100 100 100 100 % tested for HIV 12 90 90 90 90 90 % viral suppression 55.8 90 90 90 90 90 % of under 5’s treated for diarrheal 41 36 31 26 21 16 % School age children dewormed 24.6 29.6 34.6 39.6 44.6 49.6 Halt, and reverse % of adult population with BMI 5 4 3 2 1 0 the rising burden of over 25 non-communicable % Women of Reproductive age 0.05 15 30 45 60 75 conditions screened for Cervical cancers % of new outpatients with mental 0.2 0.2 0.2 0.2 0.2 0.2 health conditions % of new outpatient’s cases with 0.8 0.7 0.6 0.5 0.4 0.3 high blood pressure % of new outpatients admitted 5 0 0 0 0 0 with cancer Reduce the burden % new outpatient cases attributed 0.2 0.19 0.18 0.15 0.10 0.05 of violence and to gender-based violence injuries % new outpatient cases attributed 0.3 0.25 0.2 0.15 0.1 0.05 to Road traffic Injuries % new outpatient cases attributed 4.8 3.8 2.8 1.8 0.8 0 to other injuries % of deaths due to injuries - - - - - Provide essential % deliveries conducted by skilled 37 50 55 60 65 70 health services attendant % of women of Reproductive age 143/4 50 55 60 65 70 receiving family planning 36 % of facility based maternal 0.02 0 0 0 0 0 deaths % of facility based under five - - - - - deaths % of new-borns with low birth 27.5 22.5 17.5 12.5 7.5 2.5 weight % of facility based fresh still births 5.25 4.25 3.25 2.25 2.25 1.25 % of pregnant women attending 27.4 37.4 47.4 57.4 67.4 77.4 4 ANC visits 59 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Minimize exposure % population who smoke 14.31 11.3 8.3 5.3 2.3 1.3 to health risk factors % population consuming alcohol 27 25 23 21 19 17 regularly % infants under 6 months on 85 87 89 91 93 95 exclusive breastfeeding % of Population aware of risk 80.3 80.3 80.3 80.3 80.3 80.3 factors to health % of salt brands adequately 100 100 100 100 100 100 iodized (SURVEY) Couple year protection due to 41.9 51.9 61.9 71.9 81.9 91.9 condom use Strengthen % population with access to safe 17 28 38 48 58 68 collaboration with water health-related % under 5’s stunted 35.8 2.2 1.9 1..6 1.3 1.0 sectors % under 5 underweight 10.2 8.2 6.2 4.2 2.2 0.2 School enrolment rate 60.1 65.1 70.1 75.1 80.1 85.1 % of households with latrines 33.4 38.4 43.4 48.4 53.4 58.4 % of houses with adequate 50.9 55.9 60.9 65.9 70.9 75.9 ventilation % Schools providing complete 32.4 37.4 42.4 47.4 52.4 57.7 school health package INVESTMENT OUTPUTS Improving access to Per capita Outpatient utilization F=4.8 2 2 2 2 2 services rate (M/F) M=3.9 1.2/0.98 % of population living within 5km 21.5 31.5 41.5 51.5 61.5 71.5 of a facility % of facilities providing BEmONC 34/95 45.8 55.8 68.8 78.8 88.8 35.8 % of facilities providing CEmONC 2/6 50 67 83 100 100 33 Bed Occupancy Rate 60 65 70 75 80 80 % of facilities providing 62/95 70 75 80 85 90 Immunization 65 Improving quality TB Cure rate 85 87 89 91 93 95 of care % of fevers tested positive for 31 26 21 16 13 10 malaria % maternal audits 3/6 100 100 100 100 100 50 Malaria inpatient case fatality - Average length of stay (ALOS) 4 2 2 2 2 2 60 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 5: Standard Operating Procedures (SOPs) Data Collection Introduction Data collection is a process of gathering information (raw facts) from patients/clients, human resources, commodities, finance and/ or equipment into manual/electronic registers at the health facility by health workers or any other assigned person(s). It is a process that establishes a record of reporting and for future reference. The data is collected at the health facility on a daily and monthly basis. Materials • MOH registers • Computer (DHIS2/EHR) • Tally sheets • Hospital request forms • Patient file • Patient cards • Questionnaires Procedure 1. The health worker interacts with the patient/client and completes the relevant registers on a daily basis. 2. The health worker completes patient bio data, diagnosis, investigation and treatment 3. The health worker completes tally sheets after offering treatment. 4. Facility managers collect information related to finance, commodity, human resources and equipment on a monthly basis. 5. The health worker secures information collected and upholds confidentiality. Data Collation and Reporting Introduction Data collation is the process through which a health worker brings together data from different sources into daily/ weekly/monthly summary sheets and tally sheets. Reporting is the process of transferring information from the summary sheets in the DHIS-2/ IDSR on a daily/weekly/monthly. Materials • MOH registers • Computer.(DHIS2) • Summary sheets • Tally sheets • Patient file • Questionnaires 61 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Procedure COLLATING 1. This is done at all service delivery points. 2. Use standard tally sheet /summary sheet registers. 3. Do this by drawing tally marks to keep an accurate account of the data being collated. 4. Sum up the tallies daily. 5. Sum up the daily summaries on a weekly basis. 6. Collate data from the first to the last day of the month. 7. Data collated for a particular month should not overlap into the next month. 8. Add the outreach, emergency and other services rendered in various parts of the facility. 9. Under each event/disease count the number of events 10. Re-check totals of every event/disease. 11. Transfer totals into respective standard reporting forms at the end of the month. 12. Complete ALL fields that require data in the standard reporting forms. 13. Facility in-charge or a designated person to cross- check and sign all reporting forms. REPORTING 14. Facilities to submit report by 5th of every month. 15. Hospitals and other health facilities with the capacities to enter data from the reporting forms into the DHIS by 5th of every month. 16. Complete ALL data fields in DHIS by 10th of every month. 17. Sub-county to submit report to the DHIS by 15th of every month 18. Keep tally sheets/registers for audit purposes. Data Cleaning and Validation Introduction Data cleaning and validation is the process that takes place to ensure the highest possible quality of data is collected and processed in the routine system. The collection of high-quality data starts at the source of information where direct contact with the patient, diagnosis and/or treatment, as well as data registration, takes place. All health workers involved in the data collection are responsible for the quality of data in the health information system. Materials • Computer • Data to be cleaned • DHIS-2 • Printed outputs Procedure The M&E unit conducts the following procedures step b -step to clean and validate the data set. Checking Data for Empty Records Records that have no information (system missing) on 62 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Facility, sub-county, county and registration number variables are invalid and need to be corrected. The data management will trace the source of these invalid records, collect the correct information and report on this immediately to the responsible officer, as well as document this in the data management register (DMR). Checking Data for Missing Variables in the System Run frequencies for all variables and check missing variables in the system. Correct missing variables in the system if needed and possible. To correct the missing variables in the system, direct contact with the source of information is needed. The frequency missing variables and corrections are documented in the DMR. Checking Data for Duplicates Duplicates can be traced by using the variables that identify a unique record. These variables are also called the ‘key’ variables for identification. In case of the present dataset the key variables to identify duplicates are SUB-COUNTY-SEX-AGE. If any of the records of these key variables contain one or more variables which are missing in the system the duplicates cannot be traced and the data file cannot be validated on duplicates. Checking Data for Completeness of Reported Number of Records The county, sub-county and health facility should compare the number of reported records that can be compared with previous reports. By comparing trends over the year(s) outliers can be identified. These outliers should be reported to the county and sub-county. Surveys/ Research County / sub- county survey and research files consist of identifiable variables that preferably will not be forwarded for analyses. These identifiable variables will mostly be excluded from the data file which will be used for analyses. Data Quality Assurance Introduction Data quality assurance is the process of profiling the data to discover inconsistencies and other anomalies in the data as well performing data cleaning activities to improve the quality of data. The sub- County should constitute a data validation/review team. The chairperson of the health management team at that level should be the chairperson of this team. Materials • MOH Registers • Computer (DHIS2) • Summary registers • Tally sheets • Data quality assurance tool Procedure 1. Meet on monthly /quarterly basis to validate data before transmission. 2. Data quality assurance meetings should be weekly/monthly/quarterly. 3. Cross-check total figures on the reporting forms. 4. Check for accuracy and completeness of reports. 5. Cross-check data consistency across reports. 63 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 6. Look for unusually low or high values for events/diseases. 7. Compare with previous months and same period the year before. 8. Do necessary corrections before transmission. 9. The chairperson of the data quality assurance team should sign off the reports as having been validated. All errors detected after the submission of the reports can be changed upon submission of a completed data change request form/ data change form to the chair of the data validation. The data should be changed in all the associated data sets, both in hard copy and electronically and a higher level in charge of reporting should be informed about the changes made. Data Analysis and Synthesis Introduction Data analysis is the process of inspecting, cleaning, transforming, and modeling data with the goal of discovering useful information, suggesting conclusions and supporting decision-making. Data analysis and synthesis will be done at the county, sub-county and health facility levels to enhance evidence-based decision-making. The results obtained will be summarized into a consistent assessment of the health situation and trends, using core indicators and targets to assess progress and performance. The focus of analysis will be on comparing planned results with actual results, understanding the reasons for divergences and comparing the performance at different levels, as well as across different interventions (quarterly and annual progress reports, mid- and end-term evaluations, operation research and surveys). Data analysis and synthesis capacity will be strengthened within the CHMTs, SCHMTs and health facilities to enhance bottom-up reporting. Materials • Processed data • Statistical software • Computer • Printed out-put Procedures 1. Always indicate the level of completeness (all expected reports have been received and all forms have been filled completely without gaps) of data being used for the analysis. 2. Run simple frequencies for events and cases, sector monitoring indicators and any other variables of interest. 3. Cross tabulate events/cases by months, age, sex, location, etc. 4. Compare performance with county/sub-county targets for the level and/or historical data. 5. Draw graphs to demonstrate performance and trends. 6. Interpret findings and discuss results. Performance Review and Feedback Introduction Performance review and feedback of the health sector at the county and sub-county levels will involve preparation of an integrated report based on 3 tier health facility reports and containing the following sections: • Introduction • Service delivery achievements (indicators) • CHMT/SCHMT activity achievements • Partner activity achievements • County/sub-county performance • Lessons learnt • Recommendations 64 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) The performance reports will be compiled by representatives of county, sub-county and health stakeholders under the leadership of the county health director and the reports will be disseminated to all stakeholders on a monthly/ quarterly/bi-annual and annual basis. Material • Computer (DHIS2) • Stakeholders’ reports • County/sub-county reports Procedure 1. Assess and rank health priority indicators against targets. 2. Asses and rank the performance of county and sub-county planned activities. 3. Asses and rank the performance of stakeholders’ planned activities. 4. Incorporate research findings for evidence-based decision-making. 5. Communicate findings and provide structures for feedback/exchange of ideas and knowledge to all health stakeholders Data Dissemination Introduction Data dissemination is the release to users of information obtained. It consists of distributing or transmitting statistical data to users through various media e.g. internet, paper publication, press release, etc. Data is packaged and disseminated in formats that are determined by CHMT/SCHMT to all stakeholders. Information generated at all levels of the sector and from different sources is shared, interpreted and applied for decision-making during periodic sector performance reviews, planning, resource mobilization and allocation, accountability, designing disease specific interventions and policy dialogue. The timing of information dissemination should coincide with county planning cycles and the needs of the data users at the county /sub -county levels and of all stakeholders. Materials • Computers • Internet/intranet • Printed information product • Projector • Printer Procedure 1. Service delivery data is packaged in different formats and presented in information products. 2. Information products are printed and shared (uploaded to the website) among all stakeholders. 3. All reports produced through M&E activities are made accessible to all stakeholders. 4. M&E results users translate and use the data/information for decision-making, policy dialogue and planning. 5. Information products related to monitoring of the strategic plan is produced and disseminated during the period of the strategic plan. Performance Review and Feedback Performance review and feedback of the health sector at the county and sub-county levels will involve preparation of an integrated report based on 3 tier health facility reports and containing the following sections: • Introduction • Service delivery achievements (indicators) • CHMT/SCHMT activity achievements • Partner activity achievements 65 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) • County/sub-county performance • Lessons learnt • Recommendations The performance reports will be compiled by representatives of county, sub-county and health stakeholders under the leadership of the county health director and the reports will be disseminated to all stakeholders on a monthly/ quarterly/bi-annual and annual basis. Material • Computer (DHIS2) • Stakeholders reports • County/sub-county reports Procedure • Assess and rank health priority indicators against targets. • Asses and rank the performance of county and sub-county planned activities. • Asses and rank the performance of stakeholders’ planned activities. • Incorporate research findings for evidence-based decision-making. • Communicate findings and provide structures for feedback/exchange of ideas and knowledge to all health stakeholders. Support Supervision Supportive supervision is a process of helping staff to improve their own work continuously. It is carried out in a respectful and non-authoritarian way with a focus on using supervisory visits as an opportunity to improve the knowledge and skills of health staff. Supportive supervision encourages open, two-way communication and team building approaches that facilitate problem solving. It focuses in monitoring performance towards goals and using data for decision-making. It depends upon regular follow-up with staff to ensure new tasks are being implemented correctly. Materials • Supervision checklist • Human resources • Finance • Means of transport • Supportive supervision guidelines and tools • Stationary Procedure • Set up supervision system • Train supervisors on supportive supervision core competencies • Generate a supportive supervision plan with timelines • Decide on priority supervision sites • Visit facilities to be supervised • Review the previous action points and implementation status • Use check list and recording forms to gather information • Listen to problems and challenges 66 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) • Address and follow up on problem areas • Analyze data obtained • Provide immediate feedback to all staff • Identify training needs and skills that need updating • Give OJT on techniques and approaches, if required • Update facility supervisees on new guidelines and updates, if any • Follow up on agreed actions by supervisor and staff • Share the information on identified gaps with stakeholders • Support Supervision Checklist Format Supportive supervision checklist for use by CHMT/SCHMT Samburu County. 1. Each health facility to be visited at least once quarterly 2. Checklist to be completed in duplicate - original left at the facility and duplicate stored by the SCHMT. For each section rate performance in any of the following: 1=Excellent, 2=Good, 3=Fair, 4=Poor Date of visit: Date last visited: Facility Supervised  Yes No (tick where applicable) Facility Name PART I: Observations SECTION A. Adequacy of staffing Category Number Clinical officer Nurses Laboratory staff Clerk Support staff Security staff Others Remarks by supervisor (consider staffing norms, workload and competencies): Facility meets staffing norms Yes No Number staff members attended training during last quarter (specify training and number staff trained) Number of health personnel trained HSSF All service areas have staff allocated Yes No Overall remark on adequacy of staff: Please indicate 1=Excellent, 2=Good, 3=Fair, 4=Poor 67 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) B. Governance and financial management Component Response 1.Facility Management Committee (HFMC) in place Yes No 2.HFMC held meeting for previous quarter Yes No 3.Facility has one bank account for all incomes Yes No 4.Bank account signatories are as per guidelines Yes No 5.Facility has an APRP for the current year Yes No 6.Facility has a QIP for the current quarter Yes No 7.Facility has an HSSF for the current quarter Yes No 8.Financial management guidelines (FM Operations Guide, Guidelines on FM) available Yes No 9.Basic FM tools (Receipt books, Cash book & payment vouchers) in use Yes No 10.Latest financial report submitted Yes No Remarks by supervisor: Component Response HFMC holding regular quarterly meetings (record of minutes available): Yes No Facility meets core financial management requirements (HFMC functional, bank account, QIP Yes No available, basic tools – receipt books, cash book and payment vouchers – in use, dedicated staff for accounts): Financial information shared among stakeholders (chalkboard, meetings, etc.): Yes No Overall remark on financial management: Please indicate 1=Excellent, 2=Good, 3=Fair, 4=Poor C. Delivery of Kenya Essential Package for Health (KEPH) Service Number OPD - all visits OPD female - all visits Immunization (fully immunized) ANC clients completed 4 visits Deliveries New FP clients Long term- Short term- No malaria parasites slides done 68 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) TB patients started on treatment Patients on ART Remarks by supervisor, including quality: Service delivery appropriate for the level (KEPH package for level): Yes No Overall remark on service delivery: Please indicate 1=Excellent, 2=Good, 3=Fair, 4=Poor  D. Health and management information Report Response 1.Latest activity reports submitted to SCHRIO Yes No 2.Latest financial report submitted to accountant Yes No 3.Reports discussed in facility staff meeting (availability of minutes) Yes No 4.Finanacial and activity data “displayed” for stakeholders Yes No 4.Written feed-back from latest reports received from SCHMT / Accountant Yes No Remarks by supervisor: Activity information shared among stakeholders (chalkboard, meetings, graph display etc.): Yes No Preparation and submission of reports timely: (by 5th of every month). Yes No Facility data used for decision making: (evidence) Yes No Overall remark on HMIS: Please indicate 1=Excellent, 2=Good, 3=Fair, 4=Poor  E. Essential Medicines and Medical Supplies (EMMS) Component Response 1. EMMS received as ordered during last quarter. Yes No 2. Delivery verified and signed off by HFMC (evidence). Yes No 3. Community and users (staff ) informed of delivery Yes No 4. Stock-outs during last quarter (ACT, vaccines, cotrimoxazole, FP, paracetamol) Yes No 5. Are there local purchases of EMMS Yes No 6. Were there expiries during last quarter Yes No 69 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) 7. Stock control cards present and updated for latest delivery Yes No 8. Facility displaying quarterly information on availability of drugs Yes No Remarks by supervisor: Mechanisms of informing users and community on deliveries in place: Yes No Overall remark on availability of EMMS:Please indicate 1=Excellent, 2=Good, 3=Fair, 4=Poor  F. Utilities, equipment, infrastructure and environment Component Response(tick appropriately) Utilities   1. Availability of water Yes No 2. Availability of power source / fuel Yes No 3. Disposal of waste Yes No Basic equipment at service areas   1. MCH / FP (weighing scale, fridge, BP machine) Yes No 2. Laboratory (microscope) and others. Yes No 3. Consultation room (diagnostic set, BP machine) Yes No 4. Maternity (delivery sets, resuscitation equipment, delivery bed) Yes No Infrastructure   1. Good maintenance state for buildings Yes No 2. Compound well maintained Yes No Overall remark on utilities, equipment, infrastructure and environment: 1=Excellent, 2=Good, 3=Fair, 4=Poor  PART II: At most three identified gaps and actions needed 1 2 3    Supervised by: Name Designation/ Organization Signature Facility Stamp 70 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 6: References 1. National Health Sector Monitoring and Evaluation Framework (July 2014- June 2014) 2. Kenya Health Sector Strategic Plan (KHSSP) III (2012-2017) 3. Ministry of Health, Kenya Health Policy 2014-2013 4. Kenya Malaria Monitoring and Evaluation Plan (2009-2017) 5. Samburu County Health Sector Strategic and Investment Plan 2013-14/2017-18. 6. Kenya Demographic Health Survey (KDHS) 2014. 71 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Annex 7: List of Contributors 1. Julius Leseeto Deputy Governor 2. Stephen Lekupe CECMHS 3. Sam Nakope COH 4. Martin Thuranira CDH 5. Chris Lengusuranga MOH 6. Geoffrey Mukuria MOH 7. Fredrick Majiwa PO 8. Jospeph Rotich MOH 9. Alex Loteng Uzazi Salama 10. Christine Kiecha CMLAP II 11. Samuel Nyingi CMLAP II 12. Tom Oneko CMLAP II 13. Lepiir Paul CMLAP II 14. Ednah Omwoyo World Vision Kenya 15. Benson Lenanyokie Afya Timiza 16. Erastus Sinoti MOH 17. Dr Alex Mungai MOH 18. Josphat Lenguris MOH 19. Katra Lelesiit MOH 20. Ann Maina Afya Timiza 21. Gregory Lesikel PRB 22. Dr. Ezra Lekenit MOH 23. Lotukoi Anthony MOH 24. James Saina MOH 25. John Leshipayo MOH 26. Peter Lodikiyiaa MOH 27. Joseph Gichuki MOH 28. Emmanuel Musimbi Afya Timiza 29. Isaac Ntwiga Afya Timiza 30. Philip Koitalel Afya Uzazi 31. Thomas Maina PACE 32. Delphina Kamaan MOH 33. Mercy Lutukai JSI/Insupply 34. Robert Rapondo Afya Timiza 35. Monicah Gichu MOH 72 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022) Our Development Partners 73 SAMBURU COUNTY GOVERNMENT County Health Sector Monitoring and Evaluation Plan (2018- 2022)